After a covid baptism of fire, she went back for more

It’s hard to argue that there has been a more influential figure in medical politics over the last half-decade than GP Dr Danielle McMullen, who successively served as AMA NSW president, AMA federal vice president and AMA president.  

As she prepared to hand over the top job to fellow GP Dr Michael Bonning in November, Dr McMullen sat down for a chat with The Medical Republic. 

TMR: One of your first leadership positions had to be something of a baptism of fire – AMA NSW president, starting in 2020. What were the first big lessons you learned?  

Dr McMullen: That was such a strange time that I don’t think any of us really knew what to expect.  

I came into that role in May 2020, so the pandemic had already started – but there was still this real naivety that it would only be another few months.  

Clearly, that wasn’t the case.  

In hindsight, we then spent the next two years really just – I mean, it was a single-issue presidency. 

It was such a difficult time, but it was such an incredible time to be involved in medical leadership. 

What an absolute honour to be able to have been a state president at that time and try and be both the voice for doctors but also be part of the voice for public health. They were the two aspects of the role in that time.  

Because if we look back, general practice was often not thought of first, whether it was vaccine rollouts or PPE or workflows. There was so much uncertainty, and GPs had to daily try and figure it out.  

And I was in that boat, too, of watching the 11am press conferences – or, more often, being in clinic and having the patient at 11:30 tell me what the update was from the 11am conference – and having to pivot our workflows. 

Trying to convey to decision makers how impactful their decisions were on the everyday working lives of GPs and on patients trying to see us was one part of it. But then, at the same time, it was also trying to translate policy speak.  

I think GPs were generally pretty good at turning complex information into something that’s digestible by the general public. It’s what we do all day, every day as GPs, and so a fair bit of the role was taking the fear and the uncertainty and the constantly changing guidelines and being a public face for that.  

I think the other lesson learned was how quickly decisions can be made when there’s only one issue on the table, and everyone is genuinely trying to work together.  

Because actually, in terms of politics and policy, it was a time that everyone was – especially early in the pandemic – really genuinely coming together, was trying to do the right thing.  

It’s interesting, then, remaining in a leadership role post pandemic, when you go back to the way the real world works, and there’s so many competing priorities that it’s really hard to get momentum on things.  

Covid was the one time you actually could make a phone call and a policy would change. Everything was kind of on speed dial. 

TMR: With the chaos of covid behind you, why did you go back for more? 

Dr McMullen: Why did I stick around? Because I’m mad.  

No – to be honest, I wasn’t going to. I was pretty broken and exhausted after covid. It really was a difficult time, and I think many doctors felt that way. Not that it was an easy time for anyone, but there were some people who got to be at home or got to get new hobbies or try new things. And as doctors, we were working one or more jobs.  

While it was a real privilege trying to maintain clinical practice and the leadership role through that, I was pretty done by the end of covid and, in fact, wasn’t going to put my hand up for anything.  

There were people who wanted me to go straight to the federal presidency. Luckily, I had enough self-awareness to say no to that, because I don’t think that I was ready at that stage for that role.  

But then, when Professor Steve Robson asked me to be his vice president, I said, “Look, all right, you can twist my rubber arm, and I’ll have a go at that.”  

I could see the emerging conversations that were happening around general practice. At that stage, we already had the health minister in Mark Butler, but there was already this conversation starting to happen around, okay, what’s the future of general practice?  

Do we think about supporting models of care that already exist, or new and different ones to support people with chronic disease? How do we make sure that we still have general practice front and centre as we come out of covid and into the future?  

That was a conversation I really wanted to be a part of and stay a part of.  

It was mainly for the primary care side of stuff that I took on the vice presidency, thinking I had some more fuel in the tank for that fight.  

It was really wonderful for Steve Robson to have me be the member on the Strengthening Medicare Taskforce, because he didn’t have to do that. Often it would be the president at such a significant body like that, but we worked really well together, and to be able to be part of that group was a real privilege. 

TMR: On that note, you are in a unique position where – because you’ve been in these leadership positions successively – you’ve been able to see the whole process of a problem being identified, solutions being pitched, and government fixes being implemented. Are there any which stand out to you?  

Dr McMullen: Advocacy takes time.  

People think about these roles as two years. And, in all honesty, you rarely see much crystallising in those two years. Some certain things might come to light, but they were started by someone else, or you were part of the journey.  

Having been at the AMA for a decade now – yes, six years of those in senior roles, but around the traps for 10 to 12 years – I’ve seen some things really come to light. The ones that stand out to me are things that might not seem as big, like the kids’ health check. We lost it in about 2014, and it’s taken a decade to bring it back, but we’re really excited that from November we’ll have that back.  

It just shows that by pushing and pushing and pushing for a decade, you do sometimes get changes.  

On the general practice funding side more broadly, there’s been some progress, some wins, and some things that we still need to keep fighting for.  

There’s been lots of controversy in the AMA, in the broader medical profession, across the medical press, around the investments in general practice – that $8.5 billion, the bulk billing incentives. I think we’re all clear that if I was designing the system, it’s not how I’d design it.  

But it was still billions of dollars into frontline general practice, more than we have seen before. I think back to a couple of years beforehand, we were celebrating a $1 billion investment.  

In Dr Omar Khorshid and Dr Chris Moy’s time, there was an extra $1 billion, and that was seen as, like, this is huge money, we never get this much.  

So then to get $8.5 billion – I don’t think you can really fathom how astronomical that is, especially at a time when scope of practice pressures are so high and when so much of the public narrative is around access to other forms of care – for the dollars to actually flow to access to general practice.  

I do think we need to take that win and build from it. It’s not the finish point, but we are acknowledging that it was a significant achievement and then going, okay, well how do we shape that? And that’s now the next chapter of work, and it’s nice to see it having started.  

Then there’s the MRAC review into time-tiered items. There’s a recommendation in there about adjusting those bulk billing incentives so that they’re at least related to the length of the consultation and looking at longer consultations and how we support that comprehensive care.  

TMR: We talk sometimes about institutional knowledge – the unwritten rules, skills, and know-how that piles up when you’ve been working in a space or organisation for a long period of time. With that in mind, what advice would you give your successor, Dr Michael Bonning?  

Dr McMullen: In places like the AMA, which has such a huge remit, until you sit in this chair… 

Even having done the state presidency – we cover all doctors, all specialties, all stages of career, which means really the entire health system. It’s a really unique organisation to have that bird’s eye view of public and private, metro and rural, and public health. We have a voice in so many places, but I think the organisation is in good stead with Michael and [incoming vice president Dr Sarah Whitlaw].  

They’ve both also been around not just the AMA but broader policy health leadership for a long time. I think members and doctors can be confident that the place is in good hands.  

You’re trusting us to be your voice. We soak up your stories from around the country and spit them back to media and to leaders to try and guide policy decisions. And so, it’s a huge amount of trust that the profession puts in us. And I think they’ve made a wise decision. 

They can be confident that that next pair of hands will be safe.  

And Sarah and Michael both know that they can phone me up any time if there happens to be some little bit of knowledge squirrelled away in my brain that they can’t find somewhere else.  

TMR: There’s been a lot of talk over the past few years about whether the AMA’s membership numbers are sustainable. Why should it continue to hold importance, especially for GPs? 

Dr McMullen: Having both state and federal AMA membership and having the bodies exist at both levels is still really important – both to get that local cut through on issues and of course because some of the hospital issues are more state-based.  

But federally – decisions about Medicare, about general practice, are often made at the federal level. And we do need and to make sure that doctors have a really strong voice at the table and that, particularly, GPs have a strong voice at the table.  

The AMA is really well respected in decision-making circles. There are very few, if any, other organisations that have the access and influence that we do.  

Now, it’s not to say that we always get what we want. That’s not the way advocacy works. But we do get listened to, and that’s not because of any one president. It’s about an organisation that has built relationships over time, is careful and steady in what we suggest, and puts real thought into our policy position statements, our budget proposals and costings.  

And because we have that bird’s eye view of the health system, we’re pretty frank with our feedback. We go, hey, if you tinker with this little bit over here, you’re going to see a consequence over there that maybe you haven’t thought of.  

And I think the other factor is that we are really trying to put patients first. As much as we are here for doctors, we recognise that, as doctors, we have nothing without our patients, that’s [who] we all come to work for.  

There’s a lot of demands on doctors’ membership – that is hard-earned money. And it comes down to that. It’s a membership fee. It’s a discretionary spend.  

But my goal as AMA president has always been to get on with some of the hard conversations, so that doctors can get on with patient care and trust that someone else is having a conversation on their behalf.  

If that’s something that’s important to you as a doctor, I’d really encourage people to get membership.  

Yes, there’s all the membership benefits and partnerships and deals and things that come with it as well, and the opportunity to contribute to policy. But for me as a member, it’s always also just been about knowing that someone has my back as a profession and is out there sticking up for us. 

TMR: You’re about to go on a well-earned break, but is this the last we will be seeing of you in the health advocacy space? 

Dr McMullen: Am I going to disappear and never come back? You never know what the future holds.  

Obviously, I’ve got interest – you don’t do this job without being really interested in the way the system works, and I’ve still got some digital health roles.  

I’m stepping off to a new adventure as a parent in the short term, but then I’ll be keeping an eye out as to where my skills can be best put.  

The profession has invested a lot of time and energy in me as a health leader, and so I will endeavour to also use those skills somewhere else, because it is a pretty unique skillset of seeing right across the whole health system and getting a bit more of an understanding about how decisions are made, how the pieces of the health system fit together, and also how advocacy works and how to build a really solid advocacy position.  

So no, it probably won’t be the last you see of me – but what that’ll look like, who knows? 

TMR: What were some of the harder moments for you, if you don’t mind me asking? You’ve always made the job look pretty easy from the outside.  

Dr McMullen: It’s not easy. It’s a huge privilege, but none of that is easy.  

Pragmatically, the hours and days – every spare minute does disappear into the AMA, and trying to balance that with a clinical role and still have some time to see patients is always tricky.  

And I think the other hard bit is knowing that you can never keep everyone happy. Medicine’s a broad church, and for every policy decision or position that the AMA takes, there’ll be some people who are really happy with it, and others who aren’t. 

That criticism and that balance is part of the job, but it’s never easy. A lot of thought does go into how we make this as good as possible for as many as possible.  

I think the expectation that things can happen quicker is also hard when, as you’ve pointed out, advocacy often takes a long time. But understandably, people working day-to-day really need a solution today, and so being asked to wait is, not surprisingly, frustrating.  

I think the hardest – well, not the hardest bit, but the biggest balance in the role – is that balance of leading our profession to be the best version of ourselves, but also sticking up for ourselves.  

So that’s what I’ve worked hard to do, is to say enough, not just to GPs but to all doctors, about where I see there is scope for us to improve or think differently or modernise how we do things, but also conveying that when I’m in the room with decision makers and someone comes to attack us, I’m there to stick up for us.  

It’s that balance between leadership and protecting our tribe that’s tricky. But I guess it is what makes the job so interesting.  

TMR: We like to end these on a lighter note. Over the last six years, you’ve worked in practices in  Sydney’s inner west, as well as up in regional Queensland and now finally in Ipswich, just outside of Brisbane. Where is your dream practice location?  

Dr McMullen: Oh yes, I’ve been in Newtown, Townsville, a little bit in Cloncurry – in the middle of nowhere, near Mount Isa – and then Ipswich.  

I’m going to Canberra next, is that where all washed up political advocates go? 

Australia has it pretty good in terms of health systems. There’s plenty of nice places – working from the beach in Fiji sounds pretty attractive right now – but in terms of health systems, from talking to international colleagues, we’ve got it pretty good.  

For all our moaning, I would take the health system here over anywhere else, and maybe just transplant the Canberra winter that I’m about to face for some beachside time in the South Pacific.  

This interview has been edited for length and clarity.  

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