NEWS 13
Menopausal estrogen deficiency and the impact on women ’ s health
ausdoc . com . au 9 AUGUST 2024
NEWS 13
Fees and leave : Doctor challenges AHPRA
Rachel Fieldhouse WHEN third-year oncology registrar Dr Belle Sasse took maternity leave last year , she took non-practising status to cut her registration fees to around $ 200 a year .
Last month , she had to return to work to ensure she met her training requirements . But there was a problem .
It was just two weeks before AHPRA started accepting renewals for the 2024 / 25 registration year , meaning she faced a full annual fee of $ 995 so she could be registered for just two weeks of 2023 / 24 .
Barely a month later , she would have to renew for the next year — another $ 995 .
“ If I had delayed my return by two weeks in order to avoid paying AHPRA almost $ 1000 , at the end of the year , I would be two weeks short of my training requirements … so I would have to apply and take a registrar job in 2026 instead of becoming a fellow ,” she explained .
“ People should be charged for the portion of the year they are actually working because AHPRA is not providing any kind of service to doctors who are on parental leave ; they are not actively practising .” She asked AHPRA about paying a pro-rata fee but was told this was not an option .
Instead , she had to “ thread the needle ” by switching to full-time work so she could renew her registration in the next renewal period and still train for long enough to have a chance of fellowship .
Now , she has gone to the National Health Practitioner Ombudsman , the Minister for Health and Aged Care Mark Butler , and independent MP Dr Monique Ryan calling for change .
At the same time , AMA Victoria is also petitioning AHPRA to review its fee structure .
The petition has received 2400 signatures and was endorsed by organisations including the Pharmacy Guild of Australia , plus every AMA except NSW . AMA Victoria president Dr Jill
AAP A FORMER GP injected his 88-yearold mother with a cocktail of drugs intending to end her life and lied during subsequent investigations , a coroner has ruled .
Nelda Edwards died at her Hobart home in March 2016 , two days after her husband of almost seven decades , David Edwards .
One of the couple ’ s four sons , Dr Stephen Edwards , was charged with murdering her four weeks later , but the case was dropped in 2020 because Dr Edwards was ill .
In inquest findings last month , coroner Simon Cooper ruled that Mrs Edwards died as a result of lethal doses of midazolam and morphine administered by her son .
“[ The ] administration of those drugs … was done by [ Dr Edwards ] with the express intention of causing his mother ’ s death ,” he said .
He concluded that Dr Edwards was lying when he told the inquest he administered a “ cocktail ” of
Dr Belle Sasse with her children , Renna ( left ) and Remi ( centre ).
Tomlinson said AHPRA had told her in June it was considering the issue , but it had not responded to her request to meet AMA Victoria representatives .
“ We are disappointed that they have not , at this time , agreed to meet , and we are disappointed that their response has solely been to indicate they will review this matter ,” she said .
The plastic surgeon said AHPRA ’ s fee policy was “ inequitable and discriminatory ”.
“ It puts a greater fee burden on individuals who take parental leave , and it encourages individuals to take up non-practising registration and therefore takes them out of the healthcare workforce in a setting where we have … shortages across Australia ,” she said .
She said AHPRA should add a separate registration category for parental leave .
A spokesperson for AHPRA told Australian Doctor that it had “ heard the calls for fee relief from practitioners ”.
“[ However ] we also need to maintain the capacity of the national scheme to regulate those professions to protect the public , noting we are a practitioner-funded regulatory scheme .
“ We also understand that practitioners are affected by issues related to moving between practising and non-practising registration , and as part of our review , we are looking at ways to simplify this .”
Asked whether doctors earned enough to absorb registration fees , Dr Sasse said : “ There are many doctors who are very well remunerated for whom this fee does not represent any kind of barrier .
“ But if you have been on maternity leave for 12 months and have not earned an income , if you were working part-time before you went on maternity leave , if you were in training … you can quickly run out of your savings .
“ That is why we are asking for it to be pro-rata ; we are not asking for it to be free .”
GP gave lethal drug dose to his mum : coroner
drugs to help his mother sleep and for her back pain .
Mr Cooper said the drugs , especially morphine , were not used for those purposes .
“ I have no hesitation in concluding he was lying — not mistaken or confused , but deliberately lying — during his evidence at the inquest ,” he added .
“[ Dr Edwards ] claimed that an emergency of some type was the excuse for administering drugs prescribed for his father to his mother .
“ There was no emergency .”
Mrs Edwards told a GP she wanted to die by an injection , six days after another one of her sons died .
A third son , Leigh Edwards , said his parents had stopped eating and drinking , adding that he “ absolutely ” stood by his brother , who in his opinion provided appropriate palliative care .
“ Some people may disagree [ but ] he was very well qualified . He had been involved in palliative care all his working life ,” he said outside court .
“ He was a doctor . He knew my parents better than anyone else .”
But the coroner said Mrs Edwards had no need for palliative care , and even if she did , there was no circumstance in which her son should have provided it .
The coroner said Dr Edwards initially told police his mother had indicated she wished to be with his father , and that Dr Edwards had held her hand when she died .
Menopausal estrogen deficiency and the impact on women ’ s health
At the time of menopause , declining follicular function leads to a reduction in the reproductive hormones estrogen and progesterone . 1 The reduction of these hormones relates to more than just reproductive potential , having a much wider impact on women ’ s health . 2
Hot flushes , vulvovaginal atrophy and declining bone mineral density are symptoms that could be managed by treating the underlying estrogen deficiency . 3 , 4
Scan here to access an educational podcast series on menopause .
1 . References : 1 . Peacock K , Carlson K , Ketvertis KM . Menopause . [ Updated 2023 Dec 21 ]. In : StatPearls [ Internet ]. Treasure Island ( FL ): StatPearls Publishing ; 2024 Jan- . Available from : https :// www . ncbi . nlm . nih . gov / books / NBK507826 / ( ACCESSED MARCH 2024 ). 2 . Australasian Menopause Society . Do what makes your heart healthy . Available from : https :// www . menopause . org . au / health-info / resources / do-what-makes-your-heart-healthy ( accessed March 2024 ). 3 . The Royal Australian and New Zealand College of Obstetricians and Gynaecologists . Managing menopausal symptoms , September 2020 . 4 . Hormone Therapy Position Statement of the North American Menopause Advisory Panel . Menopause 2022 ; 29:767 – 794 .
Besins Healthcare Australia Pty Ltd ABN 68 164 882 062 . Suite 5.02 , 12 Help Street , Chatswood NSW 2067 . Office phone ( 02 ) 9904 7473 . For medical information call 1800 BESINS ( 237 467 ). www . besins-healthcare . com . au EPR-EST-PRM-2008 April 2024 .