The Secretary General of the Australian Medical Association talks to Christopher Niesche about the organisation’s political power and advocating for Australia’s medical community.

    As Secretary General of the Australian Medical Association (AMA), Anne Trimmer GAICD is in charge of an organisation with enormous political power. Its doctor members are in contact with hundreds of thousands of voters every day in their clinics and surgeries, giving the AMA huge influence when it mounts a public campaign.

    “One of the things that struck me when I first went to the AMA is the powerful voice it has, and with a powerful voice comes responsibility,” says Trimmer. “You need to use that power appropriately and that’s something that’s always at the forefront of my mind when we undertake our advocacy.”

    That powerful voice was on show when the AMA campaigned against the Medicare co-payment introduced by the Abbott Government in its 2014 budget. The co-payment would have cut $7 from the Medicare rebate patients receive from the government and leave doctors with the choice of making up the shortfall by passing it on to their patients or taking a fee cut.

    The AMA mobilised its members and those members mobilised their patients, meaning members of parliament and senators were receiving hundreds of phone calls, emails and faxes from doctors and their patients. Other bodies such as the College of General Practitioners also got involved. The campaign was a success, and after initially digging in its heels, the Government relented in March 2015 and abandoned the remaining elements of its unpopular co-payment policy.

    “When you have different electorates all around the country, each with unhappy doctors and unhappy patients, it’s very influential,” says Trimmer.

    Early beginnings

    Founded in 1962 after a period as an offshoot of the British Medical Association, the AMA is Australia’s pre-eminent doctors’ organisation. It represents doctors and medical students, and has an important advocacy role in promoting and protecting the professional interests of doctors and the healthcare needs of patients and communities. Trimmer came to the AMA not through medicine, but via law.

    She grew up in Sydney and studied law and arts majoring in English at the Australian National University. “I still enjoy English. I like both literature and also the structure and use of language. I guess that’s one of the things that you do as a lawyer – you use language a lot. It fitted in well with doing a law degree,” she says.

    Trimmer stayed in Canberra after university and joined leading local firm Macphillamy Cummins & Gibson to practise commercial law, then went onto work at Deacons Graham & James (now Norton Rose Fulbright), before finally finishing her legal career as a commercial partner at Minter Ellison, practising in both Canberra and Sydney.

    Trimmer had her first insight into the workings of government when departments started outsourcing legal services in the late 1990s and she worked on a wide range of matters, including the contracts for the new Australian passport.

    “I think the accountability requirements are different for government departments because their decision-making is ultimately answerable to parliament. There is fairly significant oversight and you’re also working quite often on security related matters.”

    “It’s an extra layer beyond the normal requirements of confidentiality that you have in the private sector.”

    While at Minter Ellison, Trimmer was elected president of the Law Council of Australia, the national body representing Australia’s lawyers. The role entailed chairing council meetings, advocating in the interests of lawyers and their clients, and being the public face of the profession in Australia.

    It was a high profile role because it came at an interesting juncture for the legal profession. The practice of law was undergoing significant structural change, with many national mergers of firms; technology changing the way legal services were delivered; and women outnumbering men among graduates going into the profession but still not breaking through into partner ranks to any great degree.

    Women still make up only about 25 per cent of partners in law firms, which Trimmer puts down to the long hours required, the expectation that lawyers should always be available for clients and the “unrelenting pressure” – all of which is incompatible with a young family.

    Trimmer says that as president of the Law Council she learned about listening to differing and sometimes conflicting views, negotiating outcomes, and the art of compromise. “I learned that acting in a respectful way around a board table or a council table is hugely beneficial and you take that into all other aspects of your life. Respectful relationships sometimes get overlooked but are really critical to successful organisations,” she says.

    “Sometimes, you see the ‘my way or the highway’ behaviour and it’s really not appropriate. You have to have decisions that everyone can live with. While not everyone around a council or board table might achieve their preferred outcome, if everyone can walk away with a decision that they can sign up to – whether it be member-based or not – that’s the preferred outcome.”

    Trimmer also came to understand the political process, the effectiveness of well-directed advocacy, and the need to work with all parties in parliament, as well as with the bureaucracy.

    Finding the AMA

    Before she joined the AMA, Trimmer had her first taste of an executive role as CEO of the Medical Technology Association of Australia (MTAA). She learned more about recruiting the right people, managing them, and letting them grow in their roles. She also gained insight into how to report to a board and importantly how to provide information and guidance from the executive to the board because as an executive she was much closer to the business and where it was heading.

    “I was interested in how you can use your skills to shape an organisation. It’s about everything from the leadership of the staff to, in the case of the MTAA, being an effective advocacy body that needed to really raise its profile. It had been around quite a long time but deliberately kept below the radar. I was brought in as a bit of a change agent to address that and lift its profile,” she says.

    When she was headhunted to join the AMA in 2013, Trimmer saw an opportunity to employ her developing advocacy skills. “I was attracted by the AMA’s advocacy influence and by the complexity of the policy issues it addresses. Health policy is probably the most challenging area of public policy because of the interweaving of so many players – public and private, federal and state, funders, providers, consumers, and of course the healthcare professionals,” she says.

    Effective advocacy starts with understanding the structure of the parliamentary process and the political decision making process. “It’s a completely different set of dynamics, engaging at the political level. Often, people approach political influencing or political advocacy assuming that it’s the minister who is the one that is going to make the decision but, in fact, it’s so multifaceted,” Trimmer says. “Yes, you need to work with the policy minister but you also need to work with their staff. You need to work with their department. You need to work with committees. You really need to spread your web very wide.”

    It is also important to work with both sides of parliament and increasingly with crossbench MPs and senators. “There is now a multitude of small parties that sit in the Senate. Their members all sit on Senate committees, which can be quite influential in particular areas of policy, and obviously they can be a blocker to government legislation that’s coming from the [Lower] House,” Trimmer says.

    Approach to advocacy

    Working with the current Senate, with its large number of senators who have come from outside traditional politics, presents its challenges. Many are from smaller, less well-resourced parties and do not have large staff numbers; they also do not have the benefit of the relevant department to advise them. Trimmer says that advocacy groups such as the AMA have to help fill the knowledge gap and provide senators with sufficient information so that they can understand the issue and see the AMA’s perspective.

    Good advocacy involves “absolute clarity” about policy. She adds, “While that sounds really obvious, I don’t think that it is always clear to advocacy organisations what it is that they are trying to put to government.”

    The AMA has a rigorous policy development process that works its way through various specialist committees and councils before final decisions are made. This ultimately provides clarity on policy issues.

    “The other component of that is coming up with solutions – offering a solution to a particular policy issue is also really beneficial. You can’t just present problems, you need to present solutions. That provides an opportunity for government to take, perhaps, a different approach to the way it may have been looking at a particular issue previously,” Trimmer says.

    “The AMA is very effective at resisting policies that we believe are not beneficial to doctors and their patients, but we also work proactively by coming up with proposals for the way in which a particular health policy might play out.”

    Advocacy bodies have to decide how to go about lobbying on each issue – with a guns-blazing media campaign or via quiet behind-the-scenes talks with key decision-makers. “It’s a judgement call,” says Trimmer.

    “Sometimes, it will be the full-on media onslaught when it’s an issue where you really want to generate public awareness of our position on something. Other times, it would be completely counterproductive to go public and go hard on something that’s better done behind closed doors in a softly, softly way.”

    Modern day challenges

    Despite the win over the Medicare co-payment, the AMA remains concerned about the ongoing freeze on Medicare rebates, which Trimmer says has quite a significant impact on the viability of general practice. The AMA is working with some general practitioners (GPs) to rethink their business models.

    In the public health space, the AMA is concerned about physical activity and obesity, and how doctors can work with their patients to encourage activity and follow a healthy diet. The organisation would like to see more investment in primary healthcare to allow GPs to properly manage the health of even quite unwell patients without having to resort to the hospital system where treatment becomes much more expensive. Despite the savings to be made from keeping patients out of hospital, preventative health makes up only a tiny percentage of the Federal Government’s health spend.

    Part of the problem is the increase in the number of patients with chronic diseases and comorbidities, who cost a lot more to treat. “It’s about getting the policy tweaks right to drive the right behaviour,” says Trimmer.

    Adding to the complexity of health policy is Australia’s federal system of government, where the states fund hospitals and the Commonwealth funds primary care. “There’s always tension around how much the Commonwealth should fund health delivery through the public hospital system in the states. Health is, for the states, an increasing part of their budget so, obviously, it’s something that remains of concern to them,” Trimmer says.

    “I don’t know that there will ever be a resolution to this. I don’t think the Commonwealth will ever become the deliverer of services, nor should it. It’s too distant from the needs of patients.”

    Hitting the headlines

    Health policy hit the headlines during the last election, with the so-called “Mediscare” campaign run by Labor, in which Opposition leader Bill Shorten claimed the Turnbull Government was planning to privatise Medicare.

    Trimmer says Mediscare was “a very effective tool in the midst of an election campaign.”

    “If you drill down further, the actual issue was about the outsourcing of the payments processing system for Medicare. The AMA has not opposed that. The system that’s in place now is 30 years old. It’s an IT system that’s potentially vulnerable and we would not oppose [outsourcing], provided that the usual sort of protections were in place, such as protection of patient information,” she says.

    “I think the campaign evolved into something much more than that in the minds of the electorate.”

    The campaign highlighted how health policy can be used for political purposes. Trimmer says the AMA has a responsibility to provide correct information and to be very careful with the language it uses in its advocacy so as not to mislead members or their patients.

    AMA changes

    Soon after taking over as secretary general of the AMA, Trimmer was responsible for reorganising its governance structure.

    For many years the Federal Council of the AMA (the major policy-setting body) was also the corporate board, but Trimmer says that with 34 members it was “very challenging” for the organisation to achieve effective strategic focus as a business.

    “It did exceptionally well as an advocacy organisation but needed to unshackle the corporate governance from medico-political policy-making,” she says. In 2014, members agreed to establish a separate board.

    Today the AMA is overseen by an 11-member board drawn from the states, plus the incumbent president, vice-president and a representative of the doctors-in-training. In just three years, Trimmer has turned the paper-based organisation digital, building a shared digital platform for its members. The AMA has also developed a platform, doctorportal, which is accessible to all doctors, not just members. Doctorportal contains tools, information, job opportunities and will increasingly focus on online learning. This focus will provide doctors all around the country access to continuing professional development education which otherwise may not be feasible, particularly for doctors working in remote and regional areas.

    One of the challenges faced by the AMA is membership numbers. Only about 30 per cent of doctors are members, which Trimmer says is because of the very rapid growth in doctor numbers over the past few years, many of whom do not join automatically.

    “There are many reasons why younger doctors might not join a professional association. I think one reason is it is competition for their dollars. They have to pay registration fees. Most of them have fees for their specialist college as well. The AMA is a nice-to-have rather than a have-to-have,” Trimmer says. Notwithstanding this, more than a quarter of the AMA’s membership base are doctors in training and are very active members.

    “I sometimes say that every doctor is indirectly a member of the AMA, but not all of them pay the membership fee. This is because our advocacy really benefits all doctors and I think making sure they understand that we speak for all doctors and that they see the value of that, would encourage more to become members.”

    Outside the boardroom

    Trimmer commutes to Canberra from the home she shares in Sydney with her husband Jeff Townsend, a principal at Endeavour Consulting, a lobbying firm for some of Australia’s largest companies.

    They have twice been named among the Australian Capital Territory’s top 10 power couples by the Canberra Times.

    Outside of work she enjoys running half-marathons. Her most recent was the Canberra half-marathon in April, which she finished in just over two hours. She also enjoys spending time with her adult children and extended family.

    She and her husband also travel, predominantly to Europe and the US. They recently returned from a two-week trip to Italy.

    “I think it’s both the familiarity of culture but also the diversity,” she says. “We have such a strong Italian subculture within Australia that Italy always feels a little bit familiar but, at the same time, it’s unique.”

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