AMA President and orthopedic surgeon Dr Omar Khorshid speaks with MedicGuild about unions, the current challenges facing Australia’s healthcare system post COVID and the medical training crisis. 

1. You were just a 5th year medical student protesting changes to medicare when you had your first interaction with the AMA. What inspired you to run for the role of president?

I started that morning as a medical student holding a placard and finished the day in a meeting with the Federal Health Minister. That was a real demonstration of the reach and influence of the AMA.

Not long after, the WA Government tried to force individual workplace agreements on interns, which would have left the least powerful group in the profession with no collective bargaining rights.

With the AMA’s assistance, we all refused to sign, and the Government backed down.

Those early experiences showed me that as an individual doctor, you can do a lot with an individual patient, but that the AMA, with tens of thousands of doctors as members, can change government policy and make a difference to public health.

If we want to enjoy access to a health system that is based around individual doctors and patients making decisions that are best for that patient, then we must be willing to fight for it.

That means being willing to challenge some of the sacred cows and defining what we think are the critical aspects of a sustainable, high quality health system.

We cannot rely on politicians to deliver a health reform agenda. If we do nothing, it is inevitable that others will come up with solutions that will be unacceptable to the medical profession.  

2. What fault lines has the pandemic revealed in Australia’s healthcare system and how will the AMA, under your leadership, seek to address some of them?

No part of the health sector will remain unscathed by COVID. Waiting lists for surgery will be longer, the health impacts including mental health and physical health will be seen for some time to come and we expect to see excess deaths from cancer and other treatable causes. 

The Victorian public health system, once lauded for its efficiency compared with the rest of the country, failed to protect the Victorian community from COVID and failed to protect its own workers, with over 3,500 health and aged care workers contracting the disease.  We have learnt that central coordination and control is critical in a health emergency and the AMA has reiterated its call for an Australian Centre for Disease Control.  We have also pushed hard for stronger national PPE guidelines to ensure that all health care workers are safe at work.

We have also realised that the physical capacity of hospitals to deal with multiple COVID patients may not be a limiting factor in a widespread COVID outbreak.  Some Victorian hospitals struggled to staff their wards and Emergency Departments as hundreds of staff were furloughed whilst others were redeployed to assist with the unfolding disaster in residential aged care facilities.

Looking forward, we expect that the Treasury coffers will have been exhausted and that health will be under the expenditure microscope. If we are to have a healthy economy in the future, we will need a healthy society. This will require investment and reform. We can’t afford to cut our way to a healthy future and the role of the AMA will be to call Governments out when they try to do this, while putting forward a positive agenda for our health system.

Stakeholders will need to understand that life will not return to normal in the foreseeable future and that it is in everyone’s mutual interest to work together if we are to meet the needs of our community. 

3. As a young doctor you saw the benefit of joining the AMA when the government was encouraging young interns to sign individual workplace agreements. Yet now we're seeing a decline in AMA membership from junior doctors. What are the benefits for junior doctors to join that AMA at this time?

AMA members have told us that they value our advocacy work highest, and at the national level we will focus more than ever on strong advocacy that delivers tangible benefits to our patients and our profession.

Most doctors have little comprehension of the breadth of issues that the AMA deals with and the many threats to the profession that are resolved before most doctors realise they exist.

The AMA negotiates employment arrangements for doctors in training in some states and territories and advocates for improvements in all. We are focusing on getting a better deal for doctors in training on issues such as better rostering, payment of overtime, access to protected training time, professional development and addressing bullying and harassment. You might be familiar with the AMA hospital health checks that are run in almost every state and territory to monitor compliance with employment arrangements. 

The more doctors in training that are our members the louder our voice is, so I would encourage every doctor in training to get involved with their AMA.

The AMA is working to refocus its communication strategies with members and other doctors, so that all doctors are aware that they have a strong representative body in their corner that is actively listening to its members and committed to achieving the best possible outcomes in conjunction with other medical groups including Colleges.

We are also considering ways to make sure the AMA is more representative of the medical profession in our leadership and representative structures. We have set a target of 40% women, 40% men and 20% flexible for improving the gender balance on our boards, councils and committees and I am committed to working towards that goal.

The AMA is the peak representative body for our profession - our challenge is to become an organisation that all doctors aspire to join.

4. You’re an orthopaedic surgeon. How many years from finishing medical school did it take for you to start training? And how many years before you became a consultant? 

It’s been a long journey. I finished my MBBS at the University of Western Australia in 1997, and started my internship and residency at Sir Charles Gairdner Hospital the next year.   I commenced Advanced Surgical Training (as it was then called) in Orthopaedics in 2003 and was awarded Fellowship of RACS in 2007.

After a year as a Consultant Orthopaedic Surgeon at Fremantle and Rockingham Hospitals, I spent a year performing Fellowships in Sydney and Scotland, before returning to Perth to commence specialist practice in 2009.  

Although it may seem like a very long time, there is so much to learn and many enjoyable, challenging and interesting experiences along the way.

5. Given the current medical training bottleneck, it’s taking junior doctors longer and longer to be able to reach that end goal, with many missing out altogether. How will the AMA work to address the crisis in medical training? 

We are working with the Commonwealth to develop a national medical workforce strategy which will give each state and territory and the medical colleges good data on where and in which specialties we need more doctors and also where we are training too many. That way, young doctors can make informed career choices.

We have also been vocal about the need to address CV buffing – where many doctors in training do a number of expensive postgraduate courses in the hope that will secure them entry into training  -unfortunately that doesn’t always happen and there is no evidence that these courses makes them better doctors. 

Dealing with the service/unaccredited registrar bottleneck is another important priority. We have called on the Commonwealth to accredit all prevocational training places so that all doctors in training have the benefit of a structured learning environment before they enter training, inclusive of career planning and mentoring.