Last week saw the bubbling over of a crisis that has been threatening the AMA for more than half a decade, but even to those paying attention it will have come as a shock.

To those of us on the outside, it sounds like an absurd riddle: How can you be a member of your state’s AMA branch, but not of the federal AMA?

Yet that is precisely the situation as of 1 March of about 5000 doctors in Western Australia, whose local AMA branch is no longer part of the national body .

Confirmation arrived last week in the form of an email alerting WA members to “the upsetting news” that their membership had ceased with the federal AMA.

Prof Steve Robson

The letter, signed by AMA president Professor Steve Robson and the entire federal board, blamed the AMA WA for abandoning the long-standing practice of collecting federal dues with state fees for forwarding them on.

As a result, there was no avenue for WA doctors to be ordinary AMA members, the letter said.

It said the AMA continued to recognise WA memberships until February 29, hoping it could convince the WA board to reverse its decision, but negotiations failed.

“These negotiations were extensive and involved multiple trips to WA by our senior leadership team. We also offered to enter mediation on multiple occasions,” the letter said.

“Our understanding is that this decision is a result of the financial situation that has been developing in WA over the past few years.

“As a membership organisation, the AMA WA Board is accountable to you for its decisions. In effect, the AMA WA Board has charged the same fee for reduced services and representation.”

Long running fee saga

Internal ructions are nothing new at the AMA, nor is conflict between the federal body and its state and territory branches over money.

Indeed, tensions spilled over back in 2021, when the AMA’s Victorian branch began offering an “associate membership”, at a 40% discount over the ordinary fees at the expense of federal membership.

This worked under the principle that around half of the membership fees are usually transferred to AMA Federal, but this “moiety” was not paid for doctors who took out an associate membership.

The national body was understandably unhappy and AMA Victoria eventually ditched the option in exchange for a renegotiated fee sharing arrangement.

But tensions remain amid concern that the Federal AMA’s budget, rumoured to be in the order of $12 million annually, is becoming simply too high for dwindling state memberships to support.

The AMA’s membership across all medical disciplines has been falling for decades; as of 2022 it was about 28,000, representing less than 30% of the country’s 104,000 doctors, compared with 50% in 1987 and 95% in the 1960s.

Belts have tightened significantly. The body’s old national headquarters, AMA House in Canberra, is now occupied by other, better resourced, organisations, and it stopped publishing its monthly magazine several years ago.

The AMA doesn’t even hold a national conference every year any more, with the most recent event – held in 2022 – a small affair compared with the gatherings of a decade earlier.

Nevertheless, there are still those who insist AMA Federal is living a champagne lifestyle on a beer budget, like the impecunious aristocrat that refuses to give up the butler and Rolls Royce even though the money has run out.

Reform demands

Dr Mark Duncan-Smith. AMA (WA)

The president of the Western Australian branch, Dr Mark Duncan-Smith, has stressed he still believes in the federal body. There is no desire for a long-term ‘WAXIT’, although the most recent formal agreement between it and AMA Federal expired in 2018.

Since then, there had been some money remitted under an interim deal, but this expired last month, he said.

“For a long time, our state association has contributed approximately 18% of the total member funds remitted to AMA Federal, despite only 10% of doctors residing in Western Australia,” he said.

“We do not believe that this is fair, and does not represent reasonable value for the members of the AMA (WA).”

Dr Duncan-Smith said an alliance calling for reform had been formed with the state bodies from Victoria, Queensland and South Australia.

“This alliance is absolutely committed to the need for reform of AMA Federal, and our interstate colleagues are equally surprised by the unilateral cessation of negotiations by the AMA Federal, and AMA Federal’s decision to contact AMA (WA) members directly earlier today without prior notice to the AMA (WA),” he said.

“We do not believe that this problem is unsolvable, and will continue to pursue it, advocating all the while for you to receive the best possible membership service.”

He concluded by stressing the WA’s position had “always been, and remains, that a Federal body is important.”

That much is undeniable. Of course, how much tighter AMA Federal’s belt can get remains to be seen.