The election of Sydney obstetrician, Dr Andrew Pesce, to the Federal AMA Presidency at the weekend is significant in a number of ways.

First, it was a clear rejection of the carping and whining style of advocacy preferred by the outgoing President, Dr Rosanna Capolingua, and her supporters. Pesce ran as the “change” candidate, with promises to engage Government, not enrage Government.

Second, it signals the demise of any influence that Dr Bruce Shepherd may still have over AMA elections or policy. The two other Presidential candidates — Dr Gary Speck and Dr Aniello Iannuzzi — had direct or indirect support from Shepherd and the Australian Doctors’ Fund (ADF). Pesce was a clear winner, easily outpolling the combined vote of his opponents.

Third, the AMA now has an almost totally new Federal Executive. The ultra-conservative Capolingua crew has been replaced by a group of moderates including new VP, Dr Steve Hambleton (Qld), Dr Roderick McRae (Vic), Dr Peter Ford (SA), and Dr Paul Bauert (NT). The only survivor is Treasurer, Dr Peter Garcia-Webb (WA), who is not a member of the AMA WA “in crowd”.

Fourth, the influence of the AMA WA and AMA Victoria, who both backed Speck, has been considerably diminished. The new power base is an alliance between AMA NSW and AMA Queensland, with strong support from the Doctors in Training group and the medical students.

This new power base was evident during the election campaign with popular former Presidents, Dr Bill Glasson and Dr Kerryn Phelps, strongly supporting the Pesce team. Pesce and Hambleton ran a “team’ ticket” with Ford and Dr John Gullotta (NSW). Gullotta, who had been earlier courted to run as Vice President to Speck, was the only member of the team not to get up.

So all the ingredients of a new-look AMA are in place, and it is sorely needed.

From all reports, AMA membership is in decline and the finances at the Federal level are under pressure, and not just because of the global financial crisis.

They need strong responsible leadership to turn things around, and Pesce is an experienced and well-respected hand. He is highly regarded on both sides of politics.

It is common knowledge that he played a key role in finding a solution to the medical indemnity crisis a few years back, winning the respect of former Health Minister, Tony Abbott, in the process.

More recently he has been a key player in the maternity services review. While strongly representing the interests of his profession, insiders say that Pesce scored points with Minister Roxon, the nurses, the midwives and the other players with his honest and collaborative approach to negotiation and debate.

His colleagues say he firmly believes that in medico-politics you have to be at the table to get results.

They say he sees engagement with Government as crucial if you want to get your arguments across and to flesh out any alternative approaches to policy.

Supporters say he is passionate that the AMA’s advocacy must have a patient and community focus as well as the overall objective of championing the medical profession.

Pesce’s Presidency is off to a flying start. On his first day in the job he met with Roxon and was entertained by the PM’s wife at The Lodge. Government advisers say that he has scored a face-to-face meeting with the PM today. This sort of access has been unheard of for the AMA in recent times.

Meanwhile, Dr Capolingua ended her reign with a National Conference Presidential farewell speech that reflected the bitterness and shallowness of her advocacy. It was a speech full of chest-thumping and personal attacks on Roxon. It was a speech full of slogans but devoid of substance. It was a c/v of failure, not achievement. Her achievements are few when compared to her predecessors.

Nevertheless, there will be plenty of people in Canberra sad to see Dr Capolingua disappear from the national scene.

Most prominent among them are Rudd and Roxon. It was easy for them to sell their health reform agenda against the predictable turf protection rants from the outgoing AMA President.

Dr Capolingua made Hanrahan look like an optimist. She was regularly claiming that Government policy was resulting in nurses harming patients, that her patients were threatening to kill themselves because bureaucrats would see their medical records, or that operating theatres in public hospitals were held together by sticky tape, masking tape and blu tac.

Also disappointed are the other health lobby groups and associations. The inability of Capolingua to articulate alternative policy left a vacuum in the health policy debate.

This vacuum was eagerly and adequately filled by the ANF, the AHHA, Catholic Health Australia, the Pharmacy Guild, the AGPN, the RACGP, the Specialist Colleges, allied health groups, and health academics from all around the country, to name just a few.

All of a sudden the expert health opinion space was no longer dominated by the AMA. People like Ged Kearney, Martin Laverty, Prue Power, David Butt, Chris Mitchell, Rob Moodie, Sally McCarthy and former AMA President Dr Mukesh Haikerwal were increasing their profile in the media and their clout with the Government.

As a result, the health policy debate is broader and more diverse and this is just how the Government likes it. It is much easier for them to bat away negativity when there is a host of supportive voices.

The challenge for Pesce is to re-establish the AMA as the nation’s “peak adviser on health care” — his words.

With the reports of the National Health and Hospitals Reform Commission, the National Preventative Health Taskforce, and the National Primary Health Care Strategy External Reference Group, among others, due for release soon, it won’t be long before we see the style and substance of the new AMA leadership.

Everyone in the health sector will be watching closely, especially AMA members.

*Dr Z wishes to remain anonymous for professional reasons.