The President's Blog

Dear fellow Members,

I recently attended a meeting in Sydney convened by AMA New South Wales and the Federal AMA to discuss medical indemnity issues.

I congratulated the newly elected President of AMA NSW, Dr Kathryn Austin. As a rule, obstetricians have a keen interest in and understanding of medical indemnity issues. Dr Austin has very useful insights, having made a major contribution to the profession’s input into the NSW Parliament’s Select Committee on ‘Birth Trauma’.

More broadly, concerns have been raised by AMA members about the recent increases in medical indemnity premiums. At their recent National Conference on the Gold Coast, delegates passed a motion seeking more information on the reasons for price increases. My response to that motion was to remind the present doctors that over 96 per cent of medical practitioners in Australia choose a doctor-owned mutual for their professional indemnity insurance.

MDA National, Avant, MIGA and MIPS are all not-for-profit entities that exist purely to serve their doctor members. All profits are returned to the business to build on the services we provide. Our members are our shareholders.

We operate in a highly competitive environment. Our businesses are closely scrutinised by the Australian Prudential Regulation Authority (APRA). We are required by law to maintain high levels of capital adequacy. We are required to show the regulator how we have made plans for various scenarios (including 1 in a 100-year events) to make sure that our capital base is not at risk.

The Government demands its regulator to keep an eye on our industry, keenly aware of its significant contribution to the industry through funding of support mechanisms like the High Cost Claims Scheme (HCCS), the Exceptional Claims Scheme (ECS) and the Run-off Cover Scheme (ROCS). Many doctors in Australia have no knowledge of what happened with the collapse of United Medical Protection 20 years ago. Tens of thousands of doctors ended up paying a ‘call’, i.e. paying an additional year’s premium upfront or over a period of five years. MDA National is proud of the fact that we never subjected our members to that impost.

A generation on, the medical indemnity industry is stable, well capitalised and well run. This is despite the numerous potential disruptors affecting our businesses, including increased plaintiff lawyer activity, the inflationary effect of the NDIS on claims, the rising cost of reinsurance, increasing levels of compliance and regulation, and the threat of cybercrime.

At our recent meeting, the MDO representatives were all assiduously aware of our need not to make even the suggestion of a breach of competition law. We did not discuss pricing at all. But we were able to give reassurance to our AMA colleagues that, just like them, we are committed to serving our members, preserving the independence of the medical profession, and providing the stability doctors need so that they can focus on the care of their patients.

Dr Michael Gannon

President

Dear fellow Members

It was a pleasure to represent MDA National and more broadly the Australian medical indemnity industry at the recent Medical Professional Liability Association (MPLA) Conference in Washington D.C. The conference started with the international cohort meeting separately.

The update from the UK included an extended discussion on their junior doctors’ strike. The consultants have settled their action with the NHS. There is the prospect of separate GP action. There is likely to be a change in government in the UK in the coming weeks but this will not necessarily herald an end to the dispute.

The most important issue in the report from our UK cousins is related to their new industry Code of Practice. The response to the Paterson case reminded me of the Shipman case where regulators, the bureaucracy and government seek to exert greater control over the medical profession, when they are dealing with crimes, not professional misconduct. The UK industry remains ‘claims incurred’ and in some ways, they are celebrating their win in not ending up with the highly prudentially regulated industry we have in Australia subsequent to the collapse of our competitor United Medical Protection in 2002.

The presentation from Canada rang all too true as they described the destruction of primary care over the last generation or two. 60 per cent of Canadians do not have a regular family doctor. Many family medicine graduates are practising purely in areas like cosmetics. They discussed the growth in their private system and the increasing number of claims pertaining to social media posts by members. Their rural workforce problems are dire. Not surprisingly, it is just as common for an international medical graduate to be placed without much support in Saskatchewan or Manitoba as it is in western Queensland or the Kimberley.

We spent some time talking about Medical Assistance in Dying (MAiD), their terminology for what we know as voluntary assisted dying. In the province of Quebec, it now accounts for 7 per cent of deaths. There are proposals to expand the remit of MAiD to include mental health conditions. It is not a common cause of claims now but they see it as an emerging risk.

The MPS representative spoke about their experience with their large international portfolio. I have personal experience of the Irish legal system. It was always fertile ground for plaintiff lawyers and medical negligence claims but it seems to be worse 20 years on. They referred to ‘trial by ambush’ as the rules of evidence are different to those in the UK and Australia. Times to settlement are years longer and third-party claims are both more common and greater in quantum.

The group had a thematic discussion on Physicians Associates. We spent most time talking about the British model which evolved from the need to field huge workforce gaps in the NHS. There has been significant pushback from the Royal College of Anaesthetists. PAs are distinct from the enhanced scope of practice roles that nurses and pharmacists have long had. Similarly, there have long been key roles for PAs in Canada in operating theatres and emergency departments. PAs are also distinct from Nurse Practitioners in rural Canada, which alike Australia, are actually independent practitioners. The increased burden of supervision is the source of greatest complaint for doctors.

The main conference contained some familiar topics. Gender affirming care is a vexing issue in the United States and internationally. The importance of a multidisciplinary approach was emphasised time and time again.

There was a good session on diagnostic errors. Not surprisingly, obstetric claims are the most expensive, many relating to delays in appropriate management on the labour ward and hypoxic ischaemic encephalopathy. There were common themes of delay in cancer diagnosis. There was a presentation on the difference between recognition and recall when it comes to detecting and acting on abnormal test results.

I explained to our colleagues the challenges we had in getting on top of claims and the increased enthusiasm of plaintiff lawyers for medical negligence work over motor vehicle injury claims. We discussed the pressures on primary care and the emergence of multi-doctor claims against general practitioners working in large practices.

It is important to take the opportunity to learn from overseas experience. It is a source of huge pride when we can reflect on the areas where we are a leader in the medical indemnity industry.

Dr Michael Gannon

President

Dear fellow Members,

MDA National recently held its Annual General Meeting, announcing the successful candidates in the Mutual Board election. I am very pleased to report the re- election of A/Professor Michael Hollands and Dr Anna Windsor.

I am also delighted to announce the election of Dr Denise Glennon, a Consultant Geriatrician at Sir Charles Gairdner Hospital in Perth. Denise brings further experience as a company director from her role as Deputy Chair of East Metropolitan Health Service in WA.

It brings me great satisfaction to observe that the Mutual Board elected by members to represent them is now 50-50 male-female with representatives from four states. Both democracy and diversity in action.

The meeting marked the retirement of Brisbane Orthopaedic Surgeon, Dr David Gilpin from both our Mutual and Insurance Boards. David has served MDA National with distinction over the past 12 years. His warmth and calm authority will be missed around the board table. I am very pleased that he has agreed to remain as Chair of our Clinical Underwriting Committee.

It is Heraclitus of Ephesus who is credited with coining the phrase ‘change is the only constant’. I do not think that I have ever had the chance of writing to my fellow MDA National Members without one or two headwinds looming. The industry and the business environment we operate in remains very challenging.

I am pleased that the investments we have made in improving and streamlining claims management have improved our bottom line. Of course, claims will never go away and in many ways represent our core business.

In my 12 years on the Cases Committee and 5 years on the Mutual Board, the same old themes prevail. Those doctors that exhibit good communication skills, and accurately and contemporaneously document what went wrong, are less likely to face legal action, or at least they give us the tools to provide them with a defence.

Perfect risk management does not stop you from needing us. The regulator still fails to sieve out the vexatious and nonsensical complaints that so harm many of our Members. Even the most gifted and careful proceduralist or clinician will eventually be involved in an adverse event.

Recently, I had the honour of speaking at a memorial service honouring our past President Dr Rod Moore. I will always be grateful for Rod’s friendship, guidance and mentorship. The people present that day were testament to the esteem in which Rod was held in both the medical and business communities.

We also said a nicer kind of farewell to Mr Steve Scudamore this year, after more than a decade as a Director of our insurance company MDA National Insurance Pty Ltd, the majority of that time as Chair. Steve has taught me so much about business and governance. We were blessed in being able to draw on his wisdom and experience over the years.

The new Chair, Mr Terry Agnew, former Group CEO of RAC WA and Director of RAA Insurance and HIF, has made a predictably seamless transition to heading the Insurance Board he has already served capably for a number of years.

Earlier this year I was fortunate enough to sit on the interview panel to select the new Director for our insurance board. I am so proud to say that the shortlist contained 5 highly capable insurance industry executives and directors, keen to contribute to our organisation.

We appointed Mr Gary Dransfield, Chair of Hollard Insurance Australia. Gary was previously CEO of Suncorp Insurance and is also Chair of the Association of Superannuation Funds of Australia (ASFA), Chair of cyber specialist underwriting agency Emergence, and a member of the Australian Financial Complaints Authority (AFCA).

Gary said something in his interview that has stayed with me. Apologies to Gary if my paraphrasing does not do him justice, but ‘most things in this life worth doing carry risk. Organisations need insurance to help manage that risk’. There is a great nobility in the way that our organisation helps contribute to patient care.

To those of you directly affected by, and otherwise close to, the ongoing human tragedies in the Middle East and Europe, our thoughts and prayers are with you. In a world of uncertainty and peril, you can always rely on your MDA National. We are strong, stable, well capitalised, and well managed.

I would like to pay tribute to our CEO Mr Ian Anderson, our senior executives, our staff all across Australia, and our colleagues that contribute to our ‘doctors for doctors’ organisation through service on our management committees.

Wishing you all a joyous Christmas and happy holiday season.

Yours sincerely

Dr Michael Gannon

Dear fellow Members,

I write to you after another successful renewal for MDA National. We never underestimate the loyalty of our Members who re-join year on year. It is a source of lament when resignations occur, especially when you become aware of the movement of an individual colleague whose skill and collegiality you admire.

Observers of economics will know that insurance costs are one of the greatest contributors to the observed increase in inflation. Compounding the more general inflationary pressures are the increase in the cost of reinsurance. Insurance and reinsurance companies are some of the biggest corporations on the planet. As an industry, they have bled money in recent years on insuring property. The increase in the incidence and severity of extreme weather events, attributable to climate change, has severely harmed their bottom line. This can make ‘casualty’ insurance like medical indemnity more attractive to them. While we were very happy with how we were able to place our reinsurance this year, the increase in costs is inevitable.

Earlier this year I attended a series of meetings with our Reinsurance panel. Explaining MDA National’s high level of clinical input into underwriting and claims management is a source of comfort for our reinsurers and ultimately helps in reducing the cost of what we spend and therefore the premiums we charge our Members. We were able to explain to reinsurers in Sydney, Singapore, Germany, and the United Kingdom the strength of our in-house legal and medical expertise and the detailed input we have from practising doctors.

As a mutual organisation, MDA National is determined to limit increases in indemnity premiums wherever possible. This involves a thoughtful and detailed analysis of emerging risks based on analysis of our own cases and learning from international experience. At MDA National we do not passively accept premium income without thinking carefully about ways to reduce the overall risk for our Members. Unlike our competitors, we do not offer discounts for new business and have an organisational culture that savings end up with our existing Members, not in the pursuit of getting other MDO members to jump.

Enhancing our capability has been the appointment of Dr Anna Windsor to the Mutual Board. Dr Windsor is a rural General Practitioner in Orange, New South Wales. She has additional expertise in medical education and medical administration. Four members of our board have qualifications in the specialty of General Practice. The Mutual Board has representatives from four states with all five mainland states represented on our management committees. Beyond this, we also have State Advisory Committees that you should feel welcome to contact if you can provide any intelligence on medico-legal risk.

Of course, we continue to invest in potential new membership, whether that be in the support of doctors in training, medical students, or newly arrived international medical graduates. Deeply ingrained at all levels of our organisation is a culture of ‘doctors for doctors’. I welcome all our new Members. I reassure our existing Members that our organisation remains strong, well capitalised, and nimble in responding to the challenges of the many disruptors in medical practice and the wider world we live in.

Sincerely

Dr Michael Gannon

Dear fellow Members,

The wise heads at Collins Dictionary chose the word Permacrisis as their Word of the Year to capture the essence of the seemingly endless period of insecurity and instability. While the war in Ukraine is deeply close and personal for some Australians, it has unsettled us all, especially those (perhaps naively) that thought we might have created a world order where international laws and borders were respected. Of course, it has had profound effects on global supply chains, energy prices, inflation and the cost of living. Much closer to home were the floods that ravished much of eastern Australia.

The COVID-19 pandemic had a direct impact on medical practice. From the early days of the novel disease when we heard stories of colleagues in China and Italy dying from infection, through the profound disruptions to our practices, and the fact that the majority of us have acquired infection over the past couple of years.

Geopolitical events have a deep impact on organisations like MDA National in impacts on the value of our investments and our ability to purchase reinsurance.

While it was difficult and risky in the competitive environment in which we operate, MDAN is proud of the brave decisions we made in putting through significant premium increases for our members. It never gives us any pleasure but it has placed us in a stronger position to withstand the inevitable challenges in the years ahead. We are equally proud of the loyalty shown by our membership with the very high renewal rates observed.

The Board and Management of MDAN do not take this loyalty for granted and we are meticulous in trying to preserve and grow the capital we are required to hold by the regulators.

In early December, MDA National staff were able to get together for the first time in three years and enjoy a conference that invigorated them in understanding of our purpose. That is to support medical practitioners through the anxiety and potential harm of a civil claim, to protect the reputation of those facing a Medical Board complaint, and to promote good medical practice.

Further, our entire organisation seeks to advocate for a better and more sustainable health system that understands how general practice, the public hospital system, the private hospitals, aged care and the mental health system can work better together to serve the needs of people across the country.

It is a great honour to continue to lead this organisation. I wish my fellow members and their loved ones a happy, restful and festive Christmas and holiday season.

Sincerely

Dr Michael Gannon

Dear fellow Members,

It was a great pleasure to attend the recent Rural Medicine Australia (RMA22) Conference as an invited guest of the Rural Doctor’s Association of Australia. It was a great opportunity to renew acquaintance with some old friends from medical school and the time I spent working as a GP locum in rural and regional Australia.

The highlight of the Conference was the RMA22 Dinner in the Great Hall of Parliament House where there were numerous awards bestowed by both the RDAA and the Australian College of Rural Remote Medicine (ACRRM). The stories of those doctors who have exhibited excellence in care and devotion to their communities warmed the heart.

The inequities in health outcomes between those of us who live in capital cities and those in the regions is too often overlooked. Part of this story is the enduring disaster of the gap between indigenous and non-indigenous Australians. There are of course realities about the greater difficulties in providing services in smaller hospitals.

Some of our actuarial data suggests that generalist surgeons in regional centres present a higher risk than sub-specialist surgeons in metropolitan areas. The nature of the demands on doctors and the varying quality of hospital infrastructure means that there will always be an inherent risk in providing GP Obstetric, GP Anaesthetic and GP Surgical services.

The clear view of the MDA National Mutual Board is that we have a responsibility to continue to provide insurance and indemnity to doctors in areas that might be intrinsically riskier to us.

It was a pleasure to meet the newly elected President of RDAA, Dr Megan Belot. It was a great pleasure to sit next to major award winner Dr Peter Rischbieth.

It was a pleasure to meet our junior doctor bursary winners. These bursaries represent another example of how we support doctors in training and try very hard to grow relationships with doctors so that they stay the course with us throughout their journey from medical student to DIT to doctor in practice.

It was a thoroughly uplifting event. I am very proud of my personal routes in rural Western Australia and believe that the medical profession as a whole, through organisations like MDA National, need to work together collectively to minimise or eliminate health inequities wherever they exist. Our support of doctors working in rural areas is testament to our whole of profession, doctors for doctors ethos.

Sincerely

Dr Michael Gannon

Dear fellow Members,

I write to you as we reach the completion of what was a difficult, yet ultimately successful renewal. Thank you for your continued support and placing your trust in MDA National to look after your professional reputation.

While there continues to be great pressure on premiums due to inflation and high claims costs, we have put in place systems to ensure that the protection we afford all of our members continues to be robust, equitable and fair.

Some craft groups had significant increases. Other specialties had no increase. A high proportion of Members will have noticed that we kept increases below inflation. Other individuals will have noticed an increase based on the collective risk of their specialty or the facts of their personal risk profile. The individual premium calculations are based on detailed and scientific actuarial analysis.

Throughout renewal, we received feedback from Members across Australia. We value that engagement with our membership and take all feedback on board (whether positive or negative) to inform our future direction and premium setting decisions.

We do not take your membership for granted, and further, your mutual board is committed to looking for new ways to add more value to your membership.

We have now reached the culmination of a difficult (but necessary) three-year process of achieving a sufficient premium pool, to address higher than expected claims experience in recent years.

We value and appreciate the loyalty of Members which is why MDA National has a policy of not offering premium discounts to attract new business. We believe this differentiates us from other insurers. It is simply not right to ask our loyal members to subsidise a commercial decision to chase new business.

Implementing our premium decisions has been a difficult task. As an Obstetrician I do not need to be reminded that some areas of medical practice are inherently riskier than others. I can assure Members that a great deal of thought goes into these matters through our staff, our highly valued appointed actuaries, a mutual board made up of your medical colleagues, and an insurance board made up of nationally renowned experts in the fields of governance, risk and insurance. I thank you again for your loyalty to our organisation. I am always happy to field your questions via president@mdanational.com.au.

Sincerely

Dr Michael Gannon

Dear fellow Members,

I recently finished watching the BBC mini-series This Is Going To Hurt. Only those of you who know me well will be more impressed that I also read Dr Adam Kay’s novel. It describes his time as a House Officer and Registrar in Obstetrics and Gynaecology in London. Dr Kay and I worked in London at the same time, but not to my recollection in the same hospital.

His book and the TV series are clever and humorous. Dr Kay and I are not alone as doctors who have worked in public O&G units to have our fair collection of stories of cleaning blood from our bodies, near misses, human tragedies, flat babies, tight shoulders, sleepless nights on-call, massive haemorrhages, various ill-placed foreign bodies, indifferent consultants, amazing midwives, and pretty bloody obvious explanations for infertility.

However, the black humour is the foreground for his commentary on an inadequately resourced public hospital system and the medico-legal risk that in turn exposes junior doctors to.

To my Intern, Resident and Registrar colleagues, I encourage you to choose an MDO who is more than just an insurer. What we provide at MDA National is not just about helping you through the potential catastrophe that might be a claim or a complaint to the regulator, but also the simple advice you might require week to week.

While MDA National is conscious of the need to be competitive on price, we concentrate on the value that doctors in training and doctors in practice get from us. Our ‘Support Protect Promote’ philosophy is not just a hashtag, but an ethos that lives across our organisation, through our Junior Doctors Committee, our Underwriting Committee, our Cases Committee, and through our Management and Board.

It is a very rare and very lucky doctor that does not need to call on their MDO from time to time. When you choose your MDO, choose the one that you think is going to be there to protect your career. For many it seems to be threatened before it has had much of a chance to start.

My service to MDA National in a variety of roles for over a decade is in no small part my way of repaying their pastoral care, legal expertise and kindness in my time of trial. I hope that none of you have to go through what I did as a Registrar. Nonetheless, the overwhelming majority of you will make that call one day, and if needed, MDA National will be there to protect you.

Sincerely

Dr Michael Gannon

Dear fellow Members,

The holiday season serves as a time to remind us of what is really important in life. I hope that most of you had a chance for a well-earned break at some stage over the summer.

Whilst many of us headed into 2022 with the hope of a happier new year than the two years past, the continued exponential rise in Omicron cases in multiple states, in particular NSW and Victoria, sent a stark reminder that our Members continue to battle the challenges of an unforgiving Covid-19 environment. Our thoughts and best wishes are with those that are working tirelessly to support their community through this latest surge.

With the activation of a code brown across multiple hospitals in the state of Victoria, coinciding with the isolation of thousands of health staff due to infections, an already overwhelmed workforce desperate to recharge, are now facing extended periods of no leave or being redeployed to different sites. We are monitoring the situation and providing support where we can to those Members affected.

Despite the challenges, camaraderie and support for each other have been evident. The MDA National team have also been working tirelessly in an ever-changing environment to ensure that our Members are aware of any regulatory changes that could impact the way they practise. This is a fast-moving pandemic where current advice can be quickly superseded by changes to government policy. However, our team remains committed to providing our Members with the most up-to-date and very best in medico-legal support and advice. You can access our latest Covid-19 FAQs here or call our team for advice on 1800 011 255.

Our thoughts are also with our Members that have been impacted financially by the reduction in non-urgent elective surgical caseload. If your billings are significantly lower than what you estimated them to be, there is no urgency to update your billings. You can advise our Member Services team at the end of the financial year.

As the rest of Australia reaches and moves beyond the peak in daily Omicron case numbers, those of us in WA face an uncertain future with the announcement of a delay in the opening of the hard border. We can only hope that the government uses the extra time in this prolonged ‘lock-out’ to ensure that the WA hospital system is ready for the inevitable influx of cases and hospitalisations once the virus sneaks in or when finally the border comes down.

I want to thank our Members for all the work that you do as the pandemic continues to put physical and emotional pressure on our workforce and our communities. As you show compassion for your patients and for your colleagues, remember to also show compassion to yourselves.

Sincerely

Dr Michael Gannon

Dear fellow Members,

MDA National recently held its Annual General Meeting, announcing the successful candidates in the Mutual Board election. On a personal note, I am very grateful to those Members who voted me back to the board. The election of existing directors Dr Mellissa Naidoo and Dr Simon Benson was a further vote of confidence in them and our collective direction.

I am also delighted to announce the election of Dr Genevieve Yates, a General Practitioner from Ballarat. Dr Yates is very familiar with the organisation, having presented educational events on behalf of MDA National for a number of years. We look forward to her contribution to the board over the next three years.

The Mutual Board recommended appointment of Brisbane Orthopaedic Surgeon, Dr David Gilpin to our Insurance Board. His experience on that board as an alternate director and his rich experience as Chair of our Underwriting Committee will serve us well in the years ahead.

It has been a difficult year. General insurers across the world are struggling with numerous issues, including the economic impacts of the COVID-19 Pandemic, extreme weather events and other broader societal changes. In the medical indemnity industry, the greatest driver of pressure is the increase in large claims. Your Mutual Board does not underestimate the challenges in the year ahead.

It is appropriate to recognise the outstanding service of my friend and colleague Dr Andrew Miller. Long before he became the outspoken President of AMA WA, and well before he achieved nationwide notoriety in demanding greater action from governments and health bureaucracies in preparing for the threat of SARS-CoV-2, Dr Miller was a tireless worker for MDA National. He has made a 23-year contribution to the organisation including longstanding membership of numerous key committees and service on our insurance board. He continues to serve as a key member of our Cases Committee Western. His contribution to the profession and the community continues in his recent election as President of the Australian Society of Anaesthetists.

While Members in New South Wales and Victoria must be absolutely delighted with the easing of restrictions, the threat of COVID-19 remains ever present. Other states of Australia that have enjoyed what they always surely knew was just a temporary hiatus from the threat of disease, face their own challenges in the months ahead. The ever-increasing vaccination rate and potentially exciting developments in post-exposure prophylaxis represent sources of optimism.

To those of you prevented from spending time with those you love and cherish by continuing border closures, my thoughts are with you. Wishing you all a joyous Christmas and happy holiday season.

Sincerely

Dr Michael Gannon

Dear fellow Members,

The COVID-19 pandemic continues to dominate the conversation, whether we are talking about serious evaluation of public policy, or the chat (at a 1.5m distance) over the neighbours’ fence. Its impact on healthcare will be long lasting. Both New South Wales and the ACT have reached 80 per cent double dose vaccination rates and are on the cusp of greater freedoms of movement. At the other extreme, in places like my home state of Western Australia, many individuals have noticed minimal disruptions to their day-to-day lives beyond being effectively locked out from the rest of the world, and often close family and friends.

COVID-19 infections have had a significant impact on our Emergency Departments, hospital wards and Intensive Care Units. With the slow but steady move towards a highly vaccinated population, the focus of managing COVID-19 will move from our hospitals to general practice.

In both general practice and other specialties we have seen the massive expansion of telehealth services. This long overdue Medicare reform has been one of the few benefits of the emergence of SARS-CoV-2. Cancellations of elective surgery in the public and private systems will have an impact in the months and years ahead.

All of these disruptions represent areas of risk for your MDA National. Through our Board and Management Committees we consider these issues carefully in keeping to our mission of supporting, promoting and protecting our members. For example, we have had to consider the legal and ethical issues around doctors resident overseas providing care to patients in Australia. Our claims teams have been fielding calls as diverse as patients complaining about refusal of mask or vaccine exemptions, accusations of overly enthusiastic promotion of vaccination, and refusal to prescribe non-evidence-based treatments.

As I have stated previously, much of this occurred against the background of our staff being kept away from the office and often needing to work while ‘home schooling’ their children.

The increasingly successful vaccine roll-out provides a source of increasing optimism. We await evidence on vaccine effectiveness and safety in 5 to 11 year olds, a greater understanding of ventilation and other workplace safety controls, and the emergence of possible antiviral treatments with anticipation.

It has been a testing time for our Members and our staff. It will continue to provide challenges for MDA National. The pandemic has led to a hardening of international markets, making our ability to purchase reinsurance on competitive terms more difficult. The pandemic has put huge pressure on the ability of many of our Members to earn a living from seeing patients. The generosity of the courts and increased plaintiff lawyer activity will not go away any time soon. Be reassured that we are ready for all the challenges ahead.

Sincerely

Dr Michael Gannon

Dear fellow Members,

I hope that many of you took the opportunity of RUOK Day to reach out to your colleagues in these difficult times. While the impact of the COVID-19 pandemic has affected people in different parts of Australia to widely varying extents, it has universally been a time of great fear and uncertainty.

Members working in Intensive Care Units and general medical wards in Sydney hospitals have been at the coalface of managing the disease and death that the infection can bring. For others there have been other less tangible disruptions to practice.

Restrictions on certain procedures have caused problems in areas like ENT surgery and Gastroenterology. Other members have had their practices disrupted by sometimes perfectly reasonable and other times heavy-handed determinations on the urgency of surgery, e.g. our colleagues in Plastic and Reconstructive surgery.

In other areas, our practices have been curtailed by the unavailability of nursing staff. The pandemic has brutally exposed our overreliance as a nation on nursing staff who come from overseas. Many of our nursing colleagues have availed themselves of the opportunity to escape the stress of our poorly resourced public hospital system, for often much more relaxed and pleasant jobs in COVID-19 testing facilities or SARS-CoV-2 vaccination programs.

The pandemic also represents something of a risk to the viability of the private medical sector. Private hospitals are an efficient, capable, and very important part of heath care delivery in Australia. They are not simply a fallback option to be used by state and territory health departments when their bed capacity is revealed to be inadequate. The levels of uncertainty and anxiety in the community also represent greater risk to medical indemnity organisations.

GPs are bearing the brunt of the ever-increasing number of requests for vaccination exemptions. It is exhausting explaining the benefit/risk equation to the sensible and inquiring ‘vaccine hesitant’, let alone handling those happy to swallow the latest fantastic theory on social media. Many have been doing a power of additional work in delivering the massive vaccine roll-out.

At MDA National, our staff understand the uncertain times in which medical practitioners live. At the same time, we are very fortunate in that the majority of us have the opportunity to go to work, to socialise to the extent we can, and to talk about the shared experience of this ongoing disruptor.

Our staff, especially those in Victoria enduring one of the planet’s longest lockdowns, and those in New South Wales who have now been at home for nearly three months, have found it difficult to engage with their teams and talk to their mates. I thank them on behalf of the Board, the Executive team and all of our members.

As we push towards 50 per cent of the Australian population being fully vaccinated, there is light at the end of the tunnel. A return to freedom of movement between the states and territories, and indeed internationally, is an important part of our ability to rest and recuperate by enjoying a holiday. Separation from loved ones is harmful. In my own practice, nearly a quarter of new mothers are kept apart from their parents in that period of equally great joy and need.

It is also important to re-establish our health care supply chains which have been impaired by the restrictions on movement of people and capital. We can only hope the arrival of spring heralds better times for our members and staff in the weeks ahead.

Sincerely

Dr Michael Gannon

Dear fellow Members,

Thank you for the loyalty you have shown the organisation and the confidence you have shown in your board members in the recent renewal. It was in the context of a number of years of adverse claims experience, and a hardening international reinsurance market, that we came to you seeking an increase in premiums for year 2021/22.

We are keenly conscious of the intercurrent disruptions to private medical practice around Australia. I have a special place in my heart for what seems like the near constant disruptions suffered by our Members in Victoria.

The Mutual and Insurance Board’s of MDA National do not take this vote of confidence for granted. We have a proud history of meticulously careful management of Members’ funds to give you the confidence to take care of your patients, knowing that you will enjoy protection and support (should you ever need it) in a civil matter or, as is increasingly the case, with a complaint to a hospital or the regulator. The whole MDAN team is thinking of our staff and our colleagues suffering through the extended lock-down in New South Wales and Victoria. We will do everything we can to support you in these difficult times.

With 10 million vaccine doses administered and more than a million doses being delivered each week, we can only hope that we are slowly but surely moving towards something like a ‘new normal’. We have not seen the last of the challenges of year 2021 or for that matter the COVID-19 Pandemic. In a world of uncertainty and disruption, the stability provided by your MDA National will continue to be a source of comfort and confidence.

Sincerely

Dr Michael Gannon

Dear fellow Members,

It has been a difficult and occasionally bruising month for many of our office staff, discussing and explaining premium increases for our Members across Australia. Management have worked hard on cost control over the past couple of years. We have communicated to Members facing a significant increase in the cost of their premium that the major driver is the cost of claims.

The truth is that insurance is becoming more expensive across the board. In the last 24 hours alone, I have had a conversation with a fellow Board member about the huge increase in the cost of Directors and Officers (D&O) Insurance in his other business. Listening to the radio this morning, I heard that the peak body for those who run carnivals and sideshows is finding it virtually impossible to obtain insurance.

This is a consequence of ‘social inflation’, where courts are becoming more and more generous in their payouts. This could be interpreted as a change in the way the judiciary thinks. It could reflect a wider societal change where people who have been injured are more likely to seek compensation. It could reflect growth in plaintiff lawyer activity. My opinion is that it is a combination of the three.

An examination of the international experience makes for very sober reading. The American publication Inside Medical Liability talks about the escalation of ‘nuclear verdicts’, some over $100 million. This adds to the costs borne by our patients. It is important that the medical indemnity providers continue to work in their own patch, helping to improve patient safety and supporting continuing education of doctors to reduce the risk of claims. It is also a reason why we need to engage with Government at industry level on sets of rules that mean that we can continue to provide cost effective health care to our patients.

These are testing times for general insurers and re-insurers. We are not immune from these changes. The increase in premiums again shows the leadership of MDA National as a medical indemnity provider in Australia. We have never subjected our Members to a call. Members should be satisfied that their organisation is always staying ahead of the game in making sure that we always have sufficient capital reserves, and doing everything we can to stay abreast of, and where possible ahead of, changes in the insurance industry, both nationally and internationally.

Sincerely

Dr Micheal Gannon

Dear fellow Members,

Recently, the doctor owned Medical Indemnity Insurers, united in our approach, wrote to Health Minister Hon. Greg Hunt MP asking for indemnity for GP members, other doctors and practice entities for their participation in the COVID-19 Vaccination Program. MDA National and our sister organisations made similar representations through our industry body, the Insurance Council of Australia earlier in the year. Those initial approaches were rebuffed by Minister Hunt.

The Government has shown no appetite to introduce a statutory no-fault compensation scheme. If that cannot be delivered swiftly, bearing in mind the urgency of the timelines, then a guarantee of indemnity is essential.

MDA National continues its advocacy through our close relationship with the AMA, discussing the importance of doctors being confident that if they administer vaccine in good faith, they will enjoy indemnity from the inevitable adverse events that will accompany the massive and unprecedented exercise that is vaccinating the entire Australian population against a novel pathogen.

The vaccine manufacturers sought and were granted immunity by the Federal Government. We sought then, and continue to seek now, similar arrangements for doctors administering vaccine in the private sector and beyond.

The ATAGI advice on the Astra Zeneca vaccine and the emergence of a seemingly idiosyncratic Thrombosis and Thrombocytopenia Syndrome (TTS) have only made the case more urgent. The community’s faith in an unprecedented whole of population vaccine roll-out will be tested if there is any reticence on behalf of trusted health professionals to administer the vaccine. Study after study has shown the high regard in which Australians hold their GPs. It is entirely reasonable that GPs would seek this protection while contributing to this hugely important public health measure.

In the event of a claim, the treating doctor might be the first point of contact. Even if there is a legal process in which the doctor and the manufacturer are both addressed in a claim, this becomes a complex and therefore expensive legal process.

Elsewhere in the world, governments are indemnifying healthcare professionals for the risks associated with administering COVID-19 vaccinations. Therefore, it will become difficult for Australian organisations like ours to purchase reinsurance in that competitive international market.

MDA National will continue to make the strongest possible representations on behalf of our Members.

Sincerely

Dr Micheal Gannon

Dear fellow Members,

Probably only the keenest observers of the medical indemnity industry are aware of the recent largely unheralded, but major, shift in the way we do business. In 2020 the regulations changed to remove the concept of Insurer of Last Resort, e.g. where MDA National was required to write a policy for a medical practitioner in Western Australia, Avant in New South Wales, irrespective of the level of risk. The new Universal Cover regulations require all insurers to make an offer to an applicant wherever in Australia they practise.

This and other impacts on the industry make it both easier and necessary for medical indemnity insurers to charge a higher premium to Members we judge to be of greater risk. This alignment of risk and premium might mean a higher premium for individuals with a history of large claims.

Some high-risk Members will search for ‘a better deal’ elsewhere. It is sad to lose Members who have been loyal to the organisation. Equally, we strive to remove cross-subsidies wherever feasible, so that the medical indemnity premium paid by an individual doctor reflects their risk and cost to the organisation.

It is all about finding the right balance between respecting our heritage and history as one that cherishes our Mutual obligations to each other, while setting competitive and fair prices for individual doctors.

There are numerous challenges for MDA National as we seek to manage our investments. While Australia has been close to world-leading in its resilience against the impact of the COVID-19 Pandemic, there is still great uncertainty with gradual withdrawal of Government support, and deteriorating conditions in markets and the insurance industry internationally.

Nonetheless, we are thoroughly committed to using this opportunity to enhance our Responsible Investment policies. We are carefully considering environmental, social and corporate governance (ESG) factors in how we manage our investments and the funds we hold on your behalf.

As Chair of the AMA Ethics Committee a few years ago, I assisted in developing an ethical investment policy which made sure that the AMA did not invest in companies involved in the production of tobacco, pornography, or weapons of mass destruction.

MDA National seeks to be more expansive in our decisions, ensuring that we do not invest in companies that use child labour or modern slavery. Further, we seek to involve ourselves in enterprises that emphasise the importance of positive climate change policies and sustainable development.

We obtain professional advice in delivering financial value to members, while having a set of values that are entirely keeping with the ethical way we treat our patients.

An organisation which represents doctors must acknowledge the relationship between human health and issues like energy efficiency, waste and pollution, and the health and safety of workers in supply chains. I can assure you all that this is core business for MDA National.

Sincerely

Dr Michael Gannon

Dear fellow Members,

It is my pleasure to introduce a new regular way of communicating with you, as your newly elected President of MDA National. It is a matter of great honour and pride that I was elected late last year, having first joined MDA National as a medical student in 1989 and being closely involved with the organisation as far back as 1993, when I was President of the Australian Medical Students Association (AMSA).

MDA National’s ethos of supporting, promoting and protecting starts when we are medical students and continues with us through our journey as junior doctors, doctors in specialist training, and then doctors in practice.

On a number of occasions, I have personally been in a position to seek the support of the organisation. I have not forgotten the support given to me during a coronial investigation as a junior registrar.

I am proud to lead a Mutual Board of diverse talents with backgrounds across many different areas of medical practice and from across Australia. You can read about our fellow elected Board Members here.

MDA National has consistently been recognised as a medical defence organisation that maintains a close relationship with its Members, supporting them in their work week by week and protecting them in their hour of need. Having been a member of our Cases Committee since 2011, I can assure you that collectively we pride ourselves on the way we manage inquiries and complaints involving our Members.

It is also our job to promote high quality medical practice. It is my intention to continue to support our outstanding education programs and to advocate on your behalf to help deliver to our patients and fellow citizens health care of the highest levels of safety and quality.

Your MDA National is strong and well capitalised, having overcome the difficulties and challenges of the one in a one hundred year whole-of-society disruptor that is the COVID-19 pandemic. I look forward to communicating with you all regularly in the months ahead.

Sincerely

Dr Micheal Gannon