When we think of a union, the Australian Medical Association does not come instantly to mind. The
august institution, formed in 1962 from what were state branches of the British Medical
Association, represents a traditionally highly paid and highly respected professional sector. The
AMA also evolved to be a powerful force in shaping policy; health ministers of all persuasions have
at various times been wary of getting on the association’s wrong side. Few blue-collar unions could
be considered analogous in their access to government and leverage over it.

But a union the AMA is, and like unions in general, finds itself afflicted with declining membership
and waning influence. As the Herald reported on the weekend, the AMA’s membership across all
medical disciplines has been steadily falling from its heyday in the 1960s, when it spoke for 95 per
cent of the nation’s doctors, and even from 1987, when it represented 50 per cent. Today the
association represents less than 30 per cent of the country’s 104,000 doctors. And in a development
that recalls the association’s antecedents, the Victorian branch has created a new membership
structure that does not send half of members’ fees to the federal body. The rupture, according to
Victorian AMA president Roderick McRae, reflects the wishes of Victorian doctors who are
“dissatisfied, for whatever reason, with the national approach” and finding the fees increasingly
unaffordable. The association’s outgoing president, Omar Khorshid, has opposed the Victorian
branch’s move.

Indeed, if one theme explains the AMA’s woes, it is fragmentation. As with the broader
workforce, the medical profession has changed significantly since the 1960s pre-Medicare era.
These days, the profession is larger and more specialised. Doctors work in more diverse practice
groups. There is a greater reliance on overseas-trained doctors, especially in regional Australia, where the burden of chronic disease is great but supply of general practitioners is not. In his
parting interview with the Herald, Khorshid rejected claims the association’s falling membership was a sign it did not represent all doctors, but it was nonetheless telling that those claims existed.

Perhaps even more worrying is the claim the AMA is struggling to read the temperature of the
public and its trusted institutions. The Victorian branch’s push for harsh restrictions during COVID
often rankled a fatigued population, not to mention former deputy chief medical officer Nick
Coatsworth, who accuses the branch of carping and fearmongering. McRae’s sarcastic outburst that
anti-vaxxers and COVID-deniers should not seek hospital treatment for a disease they denied existed sprang from understandable exasperation, but it had the ring of Twitter snark rather than responsible and compassionate public health advocacy.

In a similar vein, the Victorian branch’s motion at the weekend’s AMA conference demanding a
royal commission into the medical regulator, the Australian Health Practitioner Regulation
Authority, no doubt has its merits. The motion arises from a dispute over the Authority putting
conditions on the registration of Broome-based GP David Berger, who has raised eyebrows for his
combative zero-COVID advocacy. (Khorshid says the wording of the decision has some members
alarmed that it could be more broadly applied.) But the motion also raises legitimate questions about the AMA’s priorities and its political posture more broadly. Again, we might argue trade unions similarly diminished their standing with Australian workers when they were perceived as pursuing niche agendas and straying from their core purpose.

We hardly need to labour the importance of the AMA’s core purpose—fighting for doctors’ interests— amid the chaos COVID continues to inflict on a health system that was stretched and inefficient to begin with. It is true that doctors’ interests have rarely, if ever, perfectly aligned with the public
interest. Nonetheless, the debate over the future of healthcare in Australia stands to benefit from
coherent and unified advocacy on behalf of the medical profession. The AMA still has political
clout, but it needs a renewed clarity of purpose to more convincingly argue that doctor knows best.

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