Interview: Julia Newbould

Juggling the safety of doctors at the front line of Covid-19 as well as supporting those who have been forced to close their practice provides the Australian Medical Association (AMA) with an interesting dynamic.

Fiona Davies, head of AMA NSW, says she never expected to have to help doctors out of work – they’re generally protected from significant economic downturns. What makes it most challenging is that shutdowns aren’t due to a lack of work but because there isn’t enough personal protective equipment (PPE) to keep staff and the public safe.

“We’re trying to balance one part of our membership with the safety and wellbeing of another part of our membership, which is quite challenging,” she says.

Davies has no medical background and she’s been known to get queasy on hospital visits, but it hasn’t stopped her leading the premier doctors’ association in NSW for more than 10 years.

In addition to more than 20 years representing doctors, she is also married to neurosurgeon Brian Owler, once AMA president and Labor contender for former Prime Minister John Howard’s seat of Bennelong.

To say the couple don’t like a quiet life is an understatement. Between them they are raising four children aged 10, 11, 12 and 16. With Owler’s youngest child having autism, the couple have a strong interest in understanding the impact and joy of disability as well as the lens it brings to your life to see things differently.

They are most passionate about medicine as an opportunity for prevention, not just as a treatment. Davies sees an opportunity for doctors to set people on a path to prevention, helping them keep illness at bay, with the aim of reducing their need to visit a doctor in the first place.

The main lesson Davies says she has learnt from having a partner in medicine is the extent to which they are small business owners and how much time that takes up in addition to their clinical load.

“My husband would work very long hours in surgery and then a couple more hours each night on running a small business and various follow-ups. That’s the big thing I hadn’t fully appreciated,” she says.

Owler has continued to run his business during the pandemic: some surgery has to continue, but on a significantly reduced basis.

As a family, every day they are living the coronavirus discussions – they talk about who they are talking to in government, what different governments are doing and the latest statistics.

“The kids were quite fearful to begin with and worried about one of us getting sick,” says Davies.

This is to be expected with doctors front and centre of Covid-19 for the better part of the past three months.

According to Davies, if anything good has come from the pandemic it’s that people appreciate how effective our public health system is. She says if people have only interacted with their general practitioner in basic ways during their normal run of illness, then they probably don’t appreciate the value and strength of the Australian healthcare system.

“Health is often talked about in terms of costs, but it’s vital that people understand it’s an asset, not just a constant source of cost,” she says.

Double challenge to face

Davies says one of the most interesting aspects of the pandemic has been the reaction towards doctors from governments and the community. “When the scale of the crisis first became

The health system is often talked about in terms of costs, but it’s vital that people understand it’s an asset

apparent, the immediate priority of governments was the health and safety of our doctors,” she says.

“We all wanted to see zero deaths of healthcare workers and minimal transmission. We had to make sure the hospital system was ready and that people were protected. These are still concerns, but we are now also facing the unexpected challenge of Covid-19 being damaging to many of our members’ practices.”

A significant number of doctors and nurses have been stood down as a result of Covid-19, mostly due to the restrictions on elective survey. “The idea of significant numbers of medical practices laying off staff had not been in our experience, nor was it something we’d planned for,” says Davies.

“It’s been an odd situation of our membership facing two crises –Covid-19 and the human elements of members who at the moment can’t work, and may not be able to work for some time. Many surgical specialists have had to stop practising and that’s been unprecedented. On the other hand we had really been preparing for a world where all our doctors were completely overwhelmed.”

On top of drought and fire

Davies says she knew fairly quickly that the AMA was going to see people facing difficult situations. “Most businesses are built on the idea that income will keep coming in. As a result, not all practices made the decision to close or put themselves on leave, but we have seen a number who have seen themselves in financial difficulties. Without both private and public income, businesses closing for six to 10 weeks will impact them as much as any other business,” says Davies.

She says a lot of work has been done

The kids were quite fearful to begin with and worried about one of us getting sick

with various commercial partners to provide advice on staffing options as well as available grants, financial packages and resources.

People in general practice have been impacted, too. Davies hopes the telehealth provisions and people coming back to practices will help doctors.

What she and the association are particularly concerned about is regional and rural areas with people who have lived through drought, fire and now Covid-19, particularly those in tourist and coastal towns who have now lost another year of income.

“We’re working to reach out to regional and rural doctors directly and the NSW government has also helped.”

Everyone had prepared for working through Covid-19 – there were plans to call up students and retired doctors – but no one had planned for closing services and putting people off.

Elective surgery is now re-commencing slowly because there are still issues about how much personal protective equipment is in stock, and the increased activity in hospitals puts a strain on the remaining PPE.

Davies says there’s also a lot of concern about operating on people who might not have the coronavirus right now but might end up getting it as their body recovers from surgery.

The government has decided to phase in elective surgery by 25%, but there are still some specialists particularly concerned about risk, including head and neck surgeons, as well as ear, nose and throat surgeons.

The right prescription

Davies credits her background in industrial relations (IR) for her success at the AMA. “One of the great skills IR gives you is to always think of what’s coming next. You never think about the current action only – it’s a great skill to have because nothing in our health policy role is just about what’s in front of you; it’s about what’s in front of you and what might be a consequence of that.”

Another skill to have in your repertoire is knowing that policy and advocacy take time. “Good outcomes will usually take a couple of years and you spend most of that time feeling you’re not getting anywhere, but that’s what you should prepare for with good advocacy,” she says.

A recent example of this was doctors and trainees claiming overtime. The barrier was simple – for a doctor in training, overtime has to be approved by a listed supervisor. If that was the person responsible for promotions and positions, it was difficult for trainees to ask, says Davies.

Next, the AMA questioned employers to understand their position on overtime.

“They wanted people to claim overtime, but not to make it a free-forall,” she says. “We extended the list of people who could sign off the overtime and it was a great outcome for the doctors in training. This fixed a problem that had been around for decades.”

Based on anecdotal evidence, this change resulted in an increase in claiming all overtime from 16% to 22% of doctors. “It wasn’t about the money, it was about being valued. It was about saying to the doctors, your time is worth something and that’s what we wanted the employers to understand.

“We also wanted to see the system change. If people weren’t claiming their overtime there was no record of what was actually happening and hospitals weren’t being given appropriate resources. It’s now driven hospitals to look at the way they roster. Now they put more people on, and it’s safer for everyone.”

Mistakes with money

Other successful campaigns run with Davies at the helm include reducing alcohol-fuelled violence, which was born of a spate of attacks in Sydney’s Kings Cross.

“The police and emergency workers started the campaign, but we joined and took a significant role by putting a public face on what it means for people. We had doctors speak up and tell their side of what it’s like to lose family members and that was key to getting people to realise it could happen to them,” she says.

The “Don’t rush” campaign for road safety saw doctors taking a similar role. It ran for five years, during which time NSW achieved its lowest-ever road deaths. “It took the power of doctors to bear witness to what was happening,” says Davies.

She says championing the role of female doctors is important to her. “We have not done well enough on that at any level. To get a part-time position is almost impossible and something you have to negotiate yourself, and that’s likely to have a profound effect on women’s careers. It’s not just the number of women, but it’s the voice given to them.”

Women are still not in the leadership roles in medicine, even when they are entering the profession in equal numbers to men. Around 35% of AMA members are women.

Doctors, like women, often put themselves last when it comes to looking after their personal finances and wealth creation. Davies says she’s often put herself last in taking care of her finances such as superannuation and insurance, and she believes this is the same for many women in medicine, and some men. For women, there’s often the guilt associated with ignoring it for some time and not having done what you know you should be doing. From her own experience, she hopes to be able to help doctors help themselves and that includes focusing on adequately protecting themselves.

“For people who deal with people witnessing the worst moments of their lives, they never seem to think they are ever going to have a health problem themselves. I’m not sure what part of their psyche does that, but they’re unprepared for anything that might happen to stop them working.

“A ridiculous number are not properly insured and many make assumptions that they may be able to work without interruption, illness, accidents or health problems, which seem to cause enormous difficulties in this profession. That’s the consistent, single biggest mistake doctors make with money.”