Medicandus

Medicandus

Proposed cap on CPD claims will open the door for Big Pharma

The Federal Government announced back in April in the leadup to the Budget that the tax deduction for self-education expenses will be limited to $2000 a year. The stated point of this cap was to reduce the “opportunity for people to enjoy significant private benefits at taxpayers’ expense”. Health Minister Tanya Plibersek in response to gales of protest from the AMA and other medical groups still claimed that the reform was supposedly about “carving out what is genuine and what is necessary and what is gilding around the edges”.

My opinion on this topic is heavily biased. As the Chair of the Continuing Professional Development Committee for the Faculty of Pain Medicine, I spend a lot of (unpaid) time and effort outside of work hours organizing and thinking about CPD. I have the responsibility for worrying about how my colleagues can be kept up to speed with current research, and how the Faculty can deliver training and CPD programs that are highly effective, unbiased by commercial interests and provide good value for money. Given that CPD is a mandatory part of registration through AHPRA and our programs are regularly reviewed by the Australian Medical Council, there is no escaping it. Anyone involved in planning and running CPD activities knows very well that it’s often the last thing that doctors and other health professionals can be bothered doing after a long day at work, so you have to make the activities as enjoyable as possible to even get people to turn up. I am personally involved with several weekend workshops for trainees from around the country and everyone involved is doing it for no personal reward, yet money still has to spent in putting it on.

Both Treasurer Swan and Minister Plibersek were quite open in their public sneers at ‘conferences in the Bahamas’ and ‘first class airfares, five star accommodation and expensive courses’ which they felt were not necessary to any educational benefits received by attendees. I know how they feel. Every time I travel, I can hardly get to my seat past all the rich, fat doctors stuffed into the front of the plane on their way to Big Pharma junkets instead of being back in their surgeries. Clearly they earn so much they can just trot off whenever they want on tax-deductible fake courses which have nothing to do with compulsory CPD or improving their ability to deliver world-class healthcare on the crumbs that fall from the table in Canberra. Poor old pollies, having to fly economy everywhere they go, out of their own pockets…don’t they?

Leaving aside the sheer small-minded offensiveness of the stereotyping involved, did anyone in Treasury actually think this idea through? Even the financial and business press has been staggered by the policy suicide of introducing such a cap.

They seem to be directly attempting to drive down numbers in higher education by increasing the cost TO THE STUDENT, increase FBT burden on employers who are trying to invest in their employees’ skills and further disadvantage rural and remote communities by removing the tax break for their health workforce to be able to attend quality events. And this is meant to be a Government which values equity of access, skills development, higher education and a smart workforce!

Even the ‘class warfare’ aspect will fail. The pharma companies will love this development. I happen to know that they have been finding it much more difficult to pay for doctors to go to conferences under their sponsorship arrangements, particularly here in Victoria since we have had an allowance as part of the public hospital award agreement which has to be used for CPD purposes. Private practice doctors will be driven into the arms of the pharma companies. Let me show you how.

Say you are planning (as I am) to go to the IASP World Congress of Pain next year. It’s in Buenos Aires, as part of the IASP’s drive to be international and also to support pain management outside of the usual Europe/North America sphere. An airfare there is currently going for around $5000 for return economy. However, if I am going to keep my time away from work as short as possible, it could be more than that, as the flight times have to suit. The same flight in Business will cost over $10,000 but I will at least arrive in better shape so I can actually concentrate on the conference. The registration hasn’t opened yet but will likely be around $1000 based on previous years. The accommodation seems to run at around between $US150-300 a night. Call it at least $1000 in our money for the 5 nights of the conference. For one conference, which is pretty much the gold standard of my specialty, we are looking at a minimum of $7000 but more like $10-12,000 for the trip. Minus the cap that leaves me personally out of pocket 10 large. Or, if my employer in the public sector pays for it out of my allowance, they cop a Fringe Benefit Tax bill for something which is an entitlement under my award.

Enter Big Pharma. They will probably be happy to pay this for me. They will only ask that I give a couple of talks (from my own slides) when I get back, so they can meet their requirement to be helping me with my CPD, and spreading the word amongst other pain specialists about what I have learnt while away. The alternative is not to go. Principles are expensive, but the learning you get from attending meetings in person can be priceless. So in those circumstances, I would take the Big Pharma sponsorship. Who wouldn’t, in my position?

The real victims of this mean-spirited bit of policy are our trainees. They have neither the earning power nor the Big Pharma clout to ignore the cap. Most of them will use their entire tax deduction on their training program fee. Some training programs will cost several times the cap. They will not be able to afford to buy textbooks, go to conferences or training events or subscribe to journals without it costing them straight out of their pocket. I’m not sure what our trainees have done to deserve this sort of punishment. They are the idealistic, hard-working future of our healthcare system. They sacrifice enough to build the skills they need. It shouldn’t be made any harder than it already is.

Rural and remote health professionals will, I suspect, simply not go to events that would bring cutting-edge ideas back to their communities. As a largely urban creature myself, I would also feel deprived of the perspective that my rural and remote colleagues bring to professional discussions. Such discrimination is built into the DNA of this policy, which specifically targets travel and accommodation costs whether you are going from Darwin to Melbourne or from New York to Paris.

My advice to policymakers is to read the contributions from doctors on the #ScraptheCap website and take careful note of the damage this will do. Don’t be too proud to admit that it’s a dumb idea which will backfire. Don’t drive medical CPD back into the arms of Big Pharma funding when we are trying so hard to get free of it. Don’t cripple the minds of the next generation of healthcare professionals because of some misguided idea of what their older colleagues are like. This cap is a tax on learning and professional development. It is repugnant in principle, flawed in execution and doomed to fail at its purported purpose.