FEATURE: FUNDING FOR EXERCISE-BASED THERAPIES when this view has been expressed Figure 1 – GP recommended management and referral pathway for knee osteoarthritis, by a different medical specialist in from the Australian Clinical Care Standard, 2017 a representative position. In 1991, I sat and passed the surgical primary exam, as it turned out, the Australasian College of Sport and Exercise Physicians (ACSEP) had some inaugural training positions available just prior to creating their own primary exam, and I thought (correctly) that I could be selected for an ACSEP training position with a surgical primary. One of the surgical training program supervisors, on hearing I had done this, abused me and said it was a disgrace that I had been allowed to sit their exam when I only had intention to train in a specialty “that wasn’t real and didn’t exist”. In 2000, I felt obliged to resign from the Australian Medical Association (AMA), in reply to an enquiry as to whether the AMA could help in having my SEM training recognised as specialist training. My AMA State President wrote to me and said the AMA couldn’t help because “I hadn’t actually done any specialist training.” Various AMA Presidents and Vice- Presidents in the years subsequent knee OA as they were not medical Figure 1 is why I refused to sign the to SEM actually being recognised by specialists, and the Chair insisted that final Clinical Care Standard, in that the Australian Medical Council (AMC) medical specialists should remain as it instructs GPs to refer to “Surgeons as a medical specialty, when I was the preferred referral choices for GPs. and Rheumatologists” for knee OA, considering re-joining, changed their rather than exercise-based practitioners, stance to “SEM is in a curious position, (2) That SEM physicians should not be which I feel – based on the evidence – not being General Practice, but not really included as preferred practitioners for is simply a major error. being a specialty,” never stopping to GPs to refer to for knee OA as despite consider for a minute that the curious being medical specialists, the Chair In 2018, I asked the candidates for the position existed only because they insisted that their (SEM Physicians’) AMA Federal Presidency and Vice- refused to recognise a specialty that training and expertise, with respect to Presidency on Twitter whether they had been completely accepted by the managing knee OA, was inferior to would support equal recognition under Australian Medical Council (AMC) after rheumatologists and that therefore GPs the MBS for SEM as a physician specialty. a decade-long assessment process. should be instructed that rheumatologists One of the candidates, a hand surgeon, The curious position meant that were preferred. tweeted that the AMA wouldn’t support I wasn’t rejoining the AMA too quickly. this as – wait for it – “Sport and Exercise So, the non-medical specialists who Medicine is not a specialty in Australia”. In 2017, I was a panel member to prescribe the correct treatment (exercise) The AMA has never made any public determine the Australian Clinical Care for knee OA, missed out because of the statement on SEM (for example, not Standard for the management of knee dog whistle that they “weren’t medical congratulating SEM when it actually did osteoarthritis (OA). I had the temerity specialists”, and I call this a dog whistle get recognised as a specialty) and it didn’t to suggest that exercise-based as it is an indicator that recommendations start by correcting the blatant error of practitioners should be considered are going to be made based on hierarchy one of its Vice-Presidential candidates. priority referral recommendations for of eminence, rather than evidence. GPs treating knee osteoarthritis based However, even the medical specialists It’s notable that the last two of these on the evidence that exercise was the (SEM physicians) who prescribe the anecdotes involved female medical best available treatment for knee OA. correct treatment (exercise) missed out specialists who have been role models This was rejected by the Chair, who was also, I presume because of the recurring at promoting better access for medical a leading Rheumatologist representing mantra that “SEM isn’t a real medical specialty training for women. I’m the Australian Rheumatology Association specialty.” It absolutely couldn’t be personally aware that I am a beneficiary (who instead, went with Figure 1), based because the cortisone injections, of white privilege, male privilege, doctor on the following arguments: methotrexate, pregabalin and other privilege, private-school education drugs that rheumatologists are more privilege. It has been an eye-opener for (1) That physiotherapists (& EPs) should likely to prescribe, are better for knee me to have had to face one relatively not be included as the preferred OA than the load management that SEM minor discriminatory handicap of having practitioners for GPs to refer to for physicians are more likely to prescribe. other doctors tell me I’m not a “real VOLUME 36 • ISSUE 2 2018 39