AFRM eBulletin – 8 March 2019

The RCPA advocates for a collaborative approach for the successful introduction of pharmacogenetics in healthcare in Australia

The Royal College of Pathologists of Australasia (RCPA) has released a new position statement on the significance of genetic testing to predict a patient’s response to drugs, also known as pharmacogenetics. The RCPA is advocating for a collaborative approach with medical colleges and the wider medical profession, the Government, educators, and researchers, with the aim of creating national guidelines that will facilitate the safe and appropriate introduction of pharmacogenetics in Australia. By using pharmacogenetic testing, a clinician can align a prescription with the patient’s potential for a beneficial or adverse response to a drug. 

Commenting on the new position statement at the RCPA’s annual conference, 'Pathology Update' in Melbourne, Professor Graeme Suthers, RCPA spokesperson, said:

“This is a rapidly growing and evolving discipline in healthcare and, when compared with other countries, Australia is under-represented in terms of pharmacogenetics education, guidelines, research, rebates, and regulatory guidance. Pharmacogenetics has potential application in many areas of healthcare. Patients metabolise medications differently, sometimes as a consequence of their genetic make-up, and this can create critical variation around whether a medication is beneficial. For patients in whom the metabolism of a drug differs from the average, the appropriate response to a pharmacogenetics test result can vary from modifying the dose of the drug to selecting a drug that is metabolised by a different genetic pathway.”

“There is clear evidence that pharmacogenetics can assist in prescribing the right drug at the right dose for a given patient. It is important to stress that it does not replace the professional responsibilities of a prescriber. Pharmacogenetics provides an additional source of information that informs the prescribing physician. A pharmacogenetic test is not required for every prescribing decision, and it is just one of the many factors to be considered by a prescribing doctor. 

“There are only two pharmacogenetics tests on the MBS: these tests identify patients at risk of severe reactions to an HIV medication or a medication used in cancer and serious immunological conditions. The main source of funding for other pharmacogenetic tests is the patient, without there being support from governments or insurers. Medical colleges should seek MBS funding of those pharmacogenetics tests with sufficient evidence of validity and utility. 

“Australia does not have a national vision about assessing and developing pharmacogenetics in healthcare. Many clinicians are unaware of recent advances in pharmacogenetics and their impact on clinical practice. Educational resources should be developed for students and practising clinicians, and we need national guidelines on how to use pharmacogenetic testing appropriately,” said Professor Suthers. 

The RCPA has identified a number of areas in relation to pharmacogenetics that should be addressed by the medical community, government, educators and the public. Medications play a central role in the delivery of effective healthcare. However, medication can be costly and the benefits may be offset by side effects and risks of the medication. Pharmacogenetics provides a means of personalised prescribing, giving the right medication at the right dose to a patient. They deserve nothing less. 

For further information visit www.rcpa.edu.au or see updates on Facebook or Twitter: @PathologyRCPA or Instagram: @the_rcpa. 

A message from your President

AFRM response to the ‘Inpatient Rehabilitation after Total Knee Replacement’ article and a new version of the AFRM Inpatient Standards 

Many Fellows and trainees would be aware of the article that appeared in the Medical Journal of Australia (MJA) in August last year which concluded that “some inpatient rehabilitation is low value care.” The article was accompanied by a media release on the same topic. I am aware that a significant number of Fellows were concerned about the article and its implications. I encourage you to read our letter to the editor which has recently been published and is available on the MJA Current issues page

You will also find responses from Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ) and Australasian Rehabilitation Outcomes Centre (AROC) in the same section. Our letter concludes that “To achieve the best outcome for patients, decisions must be individualised and patient‐centred and they should start with a referral to a rehabilitation medicine physician, who can determine the right rehabilitation program, at the right time and in the right place. There are circumstances in which rehabilitation in the home (RITH) is an alternative to inpatient rehabilitation for appropriately selected patients. Let's ensure, however, that we do not throw the baby out with the bathwater”. I would also draw your attention to the RMSANZ Position Statement

I also encourage you to review the new version of the ‘Standards for the provision of Inpatient Adult Rehabilitation Medicine Services in Public and Private Hospitals’ which has recently been completed and is available on the AFRM website. This latest review has been a substantial effort for a small group of people and I would like to thank Dr Cynthia Bennett, Dr John Estell, Dr Pesi Katrak, Dr Maria Paul and Dr Angela Wills as well as members of the AFRM Council and the Policy & Advocacy Council. The end result is a significantly reviewed and updated document which also contains links to other significant AFRM documents and policies. I hope that you find it useful.

Professor Tim Geraghty 
President, AFRM

RACP Member Satisfaction Survey

We want to hear your thoughts on RACP membership via our Member Satisfaction Survey (MSS). On Monday, 25 February 2019 all RACP members (including trainees) should have received an email containing the survey link from WoolcottResearch@woolcott.com.au with the subject line 'RACP Member Satisfaction Survey – Have your say'.  

The survey should only take approximately ten minutes. Woolcott Research provides aggregated results back to the RACP and any individual comments are not identified as being by a specific member.

Please complete and have your say so we can understand your overall satisfaction with the College and identify areas for improvement. The survey closes on Wednesday, 19 March. If you have not received the survey email, please contact memberservices@racp.edu.au.

A financial session to help you understand and protect your money and wealth 

Many doctors face challenges when it comes to money, including understanding tax and the structures you need for private practice, not to mention protecting your assets, home and income. Join us for a two-hour session (attend in person or via video), Saturday, 30 March that will help you understand the financial challenges medical professionals face and how to take steps to minimise the impact for yourself and your business. 

Hear from two experts in the field, Paul Copeland and Gil Abras. Paul is a chartered accountant and Director at William Buck Chartered Accountants with over 25 years’ experience advising clients in the medical industry in relation to tax issues. Paul’s experience includes assisting practices at a start-up phase, working with group practices and assisting individuals to sell their practice. Paul’s work has seen him work with the Australian Medical Association (AMA) and he has provided education to the members of various medical colleges. 

Gil is also a chartered accountant and Director at William Buck Chartered Accountants with over 15 years’ experience advising clients, focusing on medical professionals and practice owners. Gil’s experience includes assisting practices and medical professionals with a variety of taxation and business challenges in all stages of their business cycle, creating a link between business and personal goals and objectives and ensuring the right strategy is implemented to maximise best outcomes.

Paul and Gill will provide advice and information on: 

  • tax and business advice
  • understanding the structures, you need for private practice
  • when and why you need an ABN and GST registration
  • maintaining records and knowing what you can claim as a deduction
  • timing for the payment of tax and managing the stress around cashflows 
  • property – protecting your own home
  • ownership structures
  • loans and options for structuring finance
  • purchasing an investment property and how negative gearing works 
  • wealth planning
  • protecting your income – personal insurance review
  • superannuation and self managed super funds (SMSFs) – when do you need to consider this
  • personal budgeting and cash-flow planning
  • developing a financial strategy to know where you are going.

Register your interest by emailing racpnsw@racp.edu.au or visit the event webpage for more details (attend in person or via video).

RACP Congress 2019

Join colleagues from Monday, 6 to Wednesday, 8 May 2019 at the Aotea Centre in Auckland, New Zealand, for RACP Congress 2019. As the premier annual event on the RACP calendar, Congress includes the College’s convocation ceremony as well as a diverse program with topics that span the breadth of the medical industry.

RACP Congress 2019 key topics include:

  • The key to unlocking optimal health – The life course paradigm
  • Obesity: Rising to the challenge
  • The first 1000 days – the window of opportunity for long term health
  • Medically unexplained symptoms – masterclass
  • The opioid epidemic – Iatrogenesis on a global scale
  • Integrated care – the future must be about partnerships
  • Closing plenary - Physician heal thyself

Visit the Congress website to register and view the program.

Rehabilitation Medicine Symposium

The New Zealand Faculty Members gathered in Auckland for a Rehabilitation Medicine Symposium where trainees and Fellows presented their current research on new and exciting practices in rehabilitation medicine, interesting case presentations with learning and a medical subject presentation pertinent to practices in NZ.  

As part of the event, trainee presentations were assessed for the Boris Mak Award for Best Presentation. Congratulations to Dr Sheela Perumal who won first place with her presentation ‘comparative study of the obese and underweight community dwelling older persons in a rehabilitation setting’. And congratulations to Dr Dawn Adair who was awarded second place with her presentation ‘behind bars’. 
 

International Society of Physical and Rehabilitation Medicine – 2019 registration 

The International Society of Physical and Rehabilitation Medicine (ISPRM) serves as the global agency for physical and rehabilitation medicine (PRM). ISPRM aims to 'continuously improve PRM practice and facilitate PRM input in international health organisations with the goal to contribute to optimal functioning and quality of life of people experiencing disability'. 

In order to receive the benefits of your 2019 membership and to access the members’ area of the ISPRM website use code: AFRM19#2 

The same code can be used to register for the congress when asked for ‘membership number'. 

The ISPRM member’s area on the website is currently under construction, however you can still register for the congress.

 Due to the transition process with ISPRM Central Office, all AFRM members will have to register anew. Old passwords and usernames won’t work to renew membership.

Should you have any issues registering please contact ISPRM directly via ISPRMmembership@aimgroup.eu.

Tri-Nation Alliance annual International Medical Symposium 2019

Register now for the Tri-Nation Alliance annual International Medical Symposium (IMS 2019), in Auckland, New Zealand on Friday, 22 March 2019.

The theme for the 2019 symposium is 'Visioning the impact of advanced technology on medical education' with a program featuring diverse sessions such as the debate.

Topic: Machines make better doctors? 

Four healthcare professionals debate issues of the future. What areas of medicine can machines takeover? What areas will remain with human doctors? What upskilling will human doctors need to make best use of machines?

For the affirmative

  • Physician, Associate Professor Rebecca Grainger
  • Psychiatrist, Dr David Codyre

For the negative

  • Surgeon, Mr Andrew Connolly
  • Anaesthetist, Dr Lara Hople

The debate will be followed by questions from the floor. 

Other not to be missed sessions taking place at IMS 2019: 

  • Professor Enrico Coiera – Trust and AI 
  • Professor Jenny Weller – Using simulation training to learn about non-technical skills management 
  • Associate Professor Rebecca Grainger – Current research on apps to monitor patient self 
  • Mr Andrew Connolly – Informed by AI: the systemic challenges before us 
  • Professor Jim Warren – Consumer health information revolution 
  • Mr Greg Cross – Using avatars for teaching 
  • Dr Jaron Chong – Training radiology residents when machines read imaging
  • Professor Tim Shaw – AI in trainee assessment

 View the program and register for IMS 2019.

Podcast: Cervical screening – less is more

Cervical cancer is one of the most common cancers in women worldwide, but it’s almost entirely preventable.

In December 2017 Australia was the second country in the world to adopt HPV testing as the primary tool in cervical screening. This kind of test has many benefits, such as, the increased five year interval between screens (rather than two) and the requirement for women to start being tested at age 25 instead of 18.

Some, however, are concerned about the costs and risks involved in the triage pathway. This episode of Pomegranate Health will answer some questions that women and health professionals might have about the HPV-based National Cervical Screening Program. 

Health professionals wanted 

The University of Sydney is conducting a research study to explore attitudes towards addressing sexuality among health professionals in the USA, Australia, New Zealand, United Kingdom, Ireland, Canada, Singapore and South Africa. 

You're to complete a survey which measures attitudes and barriers to including sexuality in stroke rehabilitation. 

Who can participate 
If you are a physician, nurse, occupational therapist, physiotherapist, speech pathologist, psychologist, social worker or rehabilitation counsellor working in stroke rehabilitation in Australia, New Zealand, USA, UK, Ireland, Canada, Singapore or South Africa they are looking for people like you. 

Who is running the study?  

  • Dr Margaret McGrath, Senior Lecturer at the University of Sydney 
  • Dr Emma Power, Associate Professor at the University of Technology Sydney
  • Michelle Anne Low, Honours student at the University of Sydney 

If you are interested in participating the survey can be accessed online.

For more information please read the participant information sheet and if you have any questions, contact Dr Margaret McGrath: Margaret.McGrath@sydney.edu.au.  

AFRM Examinations: 2019 Important Dates

All examination dates are now available on the College website

Applications for the rehabilitation medicine examinations opened on Monday, 4 March 2019.

If you are unsure of your eligibility for any of the rehabilitation medicine examinations, please email rehab@racp.edu.au for further details.

Applications close on Friday, 15 March 2019 at 5pm (AEDST) and no late applications will be accepted. 

For further information please email examinations@racp.edu.au.

In-Training Long Case Assessment

The current accredited list of Long Case Assessors is uploaded online and can be found on the RACP website

Education Development (Study) Grant applications

Applications are now open for the 2019 RACP AFRM Education Development Grant worth up to $10,000.

Dr Angela Wills was awarded the RACP AFRM Education Development Grant in 2018. Funding from this grant supports her attendance to the Australian Pain Society Conference and the IASP World Conference on Pain.

Applications close on Tuesday, 2 April 2018. Information about this award including eligibility criteria and the link to the online application form is available on the RACP Foundation webpage.

Refinancing made simple: your ten step guide

As a RACP member, receive a discounted rate for the life of your Macquarie home loan.

Your home loan is probably your biggest household expense – and with interest rates at an all-time low, there’s never been a better time to switch. Follow these simple steps to switch your home loan lender.

Request a call with one of Macquarie's banking specialists today and discuss the life of loan discounts that you have available through your benefits program with Member Advantage.

Find out more about our home loans on the Member Advantage website or call 1300 853 352.

Macquarie Bank Australian Credit Licence 237502. Lending criteria, fees and T&Cs apply.

RACP Submission into Royal Commission into Aged Care 

The College is preparing a submission to the Royal Commission into Aged Care Quality and Safety.

Members may contribute to this submission by sending any input relevant to the Terms of Reference to Racpconsult@racp.edu.au.

Please provide your input by COB Tuesday, 30 April and be as specific as you can.

For further information please contact Dr Kathryn Powell, Senior Policy & Advocacy Officer on +61 2 9256 5497.

Complete the survey

Since 2017, more than 30 professional organisations, including the RACP, have endorsed the ISSOP's Budapest Declaration-on the Rights, Health and Well-being of Children and Youth on the Move.  A survey has been created to capture the similarities and differences in the approach to refugee, immigrant and IDP children from paediatricians' home countries. 

RACP members are invited to complete the survey, in order to capture the insights and experiences of a large sample of physicians from Australia and New Zealand. The ultimate goal is to collect and create the largest database from the paediatric perspective on this crucial issue.

The survey contains 16 questions covering demographics, borders, health conditions, and health systems. The survey takes approximately 15 minutes.

"We need to continually question": paediatrician

Medical Board of Australia (MBA) changes to how Fellows undertake Continuing Professional Development (CPD) are set to come into effect over the next few years. The RACP is preparing Fellows for these changes by updating its MyCPD Framework from 2019 to reflect the direction the MBA is heading with its changes.

As the new MyCPD Framework comes into effect, Fellows incorporating the changes into their practice and lifestyles speak to us about their approaches to CPD.

Read more

Register now for the 2019 Combined Special Interest Group meeting – 26 to 28 July 2019 

Convened by the Leadership and Management special interest group, the theme 'Developing leaders with 20:20 vision' will explore topics of relevance to current and emerging leaders, such as:

  • inclusion and diversity
  • building healthy workplaces
  • having difficult conversations
  • medical regulation
  • digital technology.

For more information, visit the event website.The 2019 Combined Special Interest Group meeting will be held from 26 to 28 July in Sydney.

Strengthened tenancy laws for victims of domestic violence

New tenancy laws that improve and strengthen protections for victims of domestic violence in NSW start on 28 February 2019.

Under the new laws, a tenant will be able to end their tenancy immediately and without penalty if they or their dependent child are in circumstances of domestic violence. They will not be liable to pay any compensation or additional money for the early termination.

The tenant will need to give their landlord or agent a domestic violence termination notice and attach one of the acceptable forms of evidence. Evidence includes a declaration made by a medical practitioner, such as a GP.

The documents used to end a tenancy due to domestic violence cannot be used or disclosed for any other purpose (unless compelled by law). For example, a property manager cannot use these documents as part of a reference check. The documents must be stored and disposed of securely.

Landlords and agents will also be prohibited from listing a tenant on a tenancy database if they ended a tenancy in circumstances of domestic violence.

NSW Fair Trading is hosting a webinar on the new domestic violence reforms at 10am on Thursday, 28 February 2019. The webinar will go for an hour and will discuss what the reforms mean for tenants, landlords and agents.

More information on the domestic violence reforms is available on the NSW Fair Trading website

Trainee events

The Royal Australasian College of Physicians publishes notices of events and courses as a service to members. Such publication does not constitute endorsement or mandating of any such events or courses. 

Go to the events list at any time to see what events are coming up.

Bi-National Training Program (BNTP)

NSW Lecture Series – Wednesday and Saturday sessions

Events and conferences

Go to the events list at any time to see what events are coming up.

Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ)

RMSANZ is the professional body for Rehabilitation Physicians and Trainees in Australia & New Zealand.

AFRM contact details 

Member enquiries
Phone: (AUS) 1300 69 7227
Phone: (NZ) 0508 69 7227
Email: memberservices@racp.edu.au 

AFRM Faculty enquiries (including Council and committees):
Anastasia Barabash, Executive Officer, AFRM
Phone: +61 2 8076 6315
Email: afrm@racp.edu.au

AFRM NZ Committee
Lauren Darrah, Executive Officer DFAC’s NZ
Email: nz_afrm@racp.org.nz 
 
AFRM Education and Training enquiries:
Name: Lia Iliou, Education Officer
Phone: +61 2 8076 6350
Email: rehab@racp.edu.au  

AFRM Examination enquiries:
Examination Coordinator 
Email: examinations@racp.edu.au  

AFRM training site accreditation enquiries:
Name: Sonia Tao, Education Officer
Phone: +61 8247 6233
Email: accreditation@racp.edu.au 
Close overlay