MJATHE MEDICAL JOURNAL OF AUSTRALIA

N U M B E R 2 • 1 7 J A N U A R Y 2 0 1 1

CareersCareersC1

MEDICAL ONCOLOGY is a relatively

new specialty, emerging in Australia only

in the 1970s. It’s the name given to the

medical treatment of cancer patients.

More so than many other specialties,

it’s a collaborative discipline, says

Associate Professor Michael Michael,

consultant medical oncologist at the

Peter MacCallum Cancer Centre and

Chairman of the Medical Oncology

Group of Australia (MOGA), the

peak representative body for medical

oncologists in Australia.

Typically, a medical

oncologist works as part

of a multidisciplinary team

— together with surgeons,

radiation oncologists, and

other specialists, as well

as paramedical personnel,

to provide evidence-based

care in all aspects of malignant disease.

He or she is generally responsible for

diagnosing, investigating, and staging

malignancies; initiating and managing

chemotherapy, immunotherapy and/or

hormonal treatments, and managing their

side effects; and initiating or providing

palliative care.

A medical oncologist may be employed

in a major metropolitan teaching hospital

as a salaried staff specialist or a Visiting

Medical Offi cer, or a combination

of both. The role can involve doing

outreach work in a satellite centre — for

example, 1 day a week or fortnight at a

regional base hospital associated with the

metropolitan hospital.

Some medical oncologists choose to

work in the private system, where they

see patients in their private consulting

rooms and treat them in private

hospitals, and work in consultation with

other related specialists.

Medical oncologists tend to have a

subspecialty interest in particular tumour

types, says Associate Professor Michael.

“A major hospital oncology centre will

have several teams, each focusing on a

particular type of cancer, so you may

have a specifi c team that manages breast

cancers, and another team that manages

colorectal cancers, for example”, he says.

A medical oncologist may be involved

with more than one team in a centre.

In private and regional practices, the

approach may be more generalised, and

an oncologist may manage a broader

range of cancer types, liaising with

surgeons and other specialists.

A typical day involves ward rounds,

clinics, multidisciplinary clinical

meetings and (particularly in the larger

centres) academic work and research, as

many large oncology centres (private and

public) are involved in clinical trials.

What are the requirements for the

role? A good grounding in general

medicine is essential, says Associate

Editor: Peter Lavelle • plavelle@ampco.com.au • (02) 9562 6666

continued on page C5

Targetingcancer

In this issue

C1 A career in medical oncology

C3 How a testamentary trust can help your estate planning

C4 Dr Peter Spitzer: Clown Doctor

C2 & C9 Specialist Appointments

C5 & C13 Hospital Appointments

C6 - C7 Locums

C11 Overseas Appointments

C13 GP Opportunities

A career in the medical management of cancer requires a combination of clinical

expertise with a measure of wisdom, collaboration and compassion.

www.mjacareers.com.au • Number 2 • 17 January 2011MJA Careers

C2

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www.mjacareers.com.au • Number 2 • 17 January 2011MJA Careers

C3

DO you worry about what will happen to

your wealth after you die? Do you fear it

might be squandered or whittled away by

the actions of your benefi ciaries?

If so, you should consider rewriting your

will to include a testamentary trust.

That’s the advice of lawyers and estate

planners, who say that a testamentary trust

is a good way of ensuring that your wealth

is passed on to your benefi ciaries in the

most advantageous way possible.

“A testamentary trust is a trust that’s

established by a will and comes into

existence on the death of the will-maker”,

explains Michael Fitzpatrick, a solicitor

and barrister at PricewaterhouseCoopers

Australia who specialises in estate

planning.

More correctly, it’s often called an

“optional discretionary testamentary”

trust (“optional” because the main

benefi ciary decides whether or not to use

it, and “discretionary” because the main

benefi ciary decides who will benefi t from

it).

The big advantage of a testamentary trust

is the fl exibility it offers, compared with a

standard will, he says.

In a standard will, you leave an

inheritance directly to nominated

benefi ciaries as set out by the will. But in

a will that creates a testamentary trust,

you leave the inheritance to a nominated

benefi ciary as a trustee of the discretionary

trust. The trustee determines which of the

nominated benefi ciaries, if any, receive any

income or capital from the testamentary

trust, and when.

This can give rise to substantial tax

savings among the benefi ciaries, and

can help protect the inheritance from

creditors who may have claims against the

benefi ciaries.

Tax savings Normally a benefi ciary who inherits assets

has to pay tax on any income earned

from those assets at his or her personal

tax rate. But the income from assets in

a discretionary testamentary trust can

be distributed at the discretion of the

trustee to low-income benefi ciaries — for

example, to a non-working spouse — so as

to achieve a tax saving.

Normally, income from a trust paid to

a minor (a child aged under 18 years)

attracts tax at high penalty tax rates.

But income distributed to a minor

from a testamentary trust attracts the

same marginal tax rate as an adult. “So

benefi ciaries under 18 could receive over

$20 000 of income annually, tax-free”, says

Fitzpatrick.

There are also signifi cant capital gains

tax benefi ts in preferentially distributing

capital gains from the sale of assets from

the estate.

Asset protectionAsset protection is the other big advantage

of testamentary trusts, says Melbourne

solicitor Terry McMaster, of McMasters

Accounting, Legal and Financial Planning.

For example, a trust can provide

protection of the assets in the event of

bankruptcy of a benefi ciary, he says. If a

benefi ciary has a failed business venture,

for example, and is facing the prospect

of bankruptcy, then any asset he or

she inherits as part of the estate under

a standard will may be seized to pay

creditors.

But if held by the testamentary trust,

these assets do not legally form part of

the benefi ciary’s personal assets and can

continue to be held by the trust, and the

creditors cannot touch them.

A testamentary trust may also provide

protection from family law claims, says

McMaster.

“Suppose, for example, you have a

daughter who has a rocky marriage. The

risk is that you die leaving a substantial

amount to her, but the couple divorces

shortly after your death, so that a

substantial part of your inheritance is

awarded to your former son-in-law by the

Family Court”, he says.

“However, if her share of your estate was

instead left to a testamentary trust, then she

would not legally own her share of your

estate and her ex-husband would be unable

to make a claim on the assets.”

A testamentary trust may

protect assets against poor

decisions made by benefi ciaries

who are fi nancially naïve or

have other problems. “If a family

member is a spendthrift or has

a drug problem and is likely to squander

the money, that family member may be

given the benefi t of certain assets, such

as a family home, but be prevented from

actually selling the home. The family

home might then go to the grandchildren

in equal shares on the death of the son.

This may sound like an extreme option,

but at least the son gets a roof over his

head during his life which he can’t lose,

no matter what else he may do”, says

McMaster.

The will must be correctly worded

to allow the trustee as many options as

possible, so as to provide this freedom and

fl exibility, says Michael Fitzpatrick.

Testamentary trusts do entail additional

administration and accounting costs. It’s

important to consult your accountant,

solicitor and/or fi nancial adviser, to ensure

that this additional cost is worthwhile and

to make sure it addresses your particular

needs, he says.

Money and Practice MJA Careers looks at issues that affect the bottom line of your practice

The big advantage of a testamentary trust is the fl exibility it offers, compared with a standard will

Testamentary trustsA testamentary trust allows you some fl exibility in what happens to your wealth after your death.

www.mjacareers.com.au • Number 2 • 17 January 2011MJA Careers

DR PETER SPITZER is a general practitioner who practises in

the New South Wales country town of Bowral. He is also known

as “Dr Fruit-Loop”, a clown doctor who, along with Jean-Paul

Bell, founded The Humour Foundation, a charity dedicated to

promoting the health benefi ts of humour. The Foundation’s core

project is the Clown Doctor program. There are now over 50

clown doctors Australia-wide, who visit sick children in hospital

and use laughter to help them get through their treatment.

By parodying the hospital routine, Clown Doctors reduce the

children’s fear and anxiety so that they feel less traumatised by

medical procedures. Here’s how Dr Fruit-Loop spends a typical

day.

One Day

6.00

Love the morning. The fi rst 1 1/2 hours are my time. Time

for stretches, exercises, reading and practising performance

routine, including close-up magic. Never forget breakfast.

7.00

This is a day for Dr Fruit-Loop, Clown Doctor, to visit

the Sydney Children’s Hospital (our “birthing hospital”

in 1997). Clean, check and pack up props for the day.

Prepare Dr Fruit-Loop’s costume.

8.00

Sometimes it’s a 2-hour drive from Bowral. In the car, it’s

time to listen to the ABC as well as comedy. Nothing like a

laugh in traffi c jams.

10.00

Arrive at the hospital and meet my Clown Doctor partner

for the day. Today, it’s Lauri - Dr S Duffer. Getting into

costume and getting into character is the way to start.

We check costumes, make-up, some songs (uke and

harmonica today) and then referrals for the day. Also check

performance book for comments from previous visit.

Clown rounds start. We spend time with staff fi rst. Here

we enjoy brief play, magic, chaos and serenading while

we get a “handover”. We’re on the lookout for what’s right

with the patient. “Improv” rules the day.

Today, we visit the medical, orthopaedic, oncology, pre-

op, outpatient and intensive care units.

Along the way, we prescribe mirth, dispense laughter

and often leave our patients in stitches.

In the middle of this, we take off our coats and schnozes

to have some lunch and catch up with the day’s activities

so far.

3.00

De-brief. Time to talk. Time to write reports. Stories are

important. We leave messages for the next team of Clown

Doctors.

4.00

Off comes the costume and make-up. It’s been a magical

day.

5.00

A 2-hour drive back to Bowral. Sometimes it’s the ABC on

the radio, sometimes its comedy and sometimes it’s silence.

7.00

Home for dinner. We talk, talk, talk. Unpack and put away

Dr Fruit-Loop’s gear.

8.00

Check emails, attend to phone calls and review pathology

results online

11.00

I fall asleep on the

way to the pillow.

What do doctors do all day? One Day gives a glimpse into one doctor’s life

C4

For more information about The Humour Foundation and the Clown Doctor project, visit http://www.humourfoundation.com.au.

www.mjacareers.com.au • Number 2 • 17 January 2011MJA Careers

C5

Professor Michael. Although most cancers

are initially local, as they spread they involve

other organs and often have generalised

systemic effects as a result of the disease itself

or its treatment. Many patients with cancer

also have comorbidities. So you need a good

grasp of internal medicine generally, he says.

Not surprisingly, the role best suits

someone who enjoys collaborating with

others and working in a team.

It also requires someone with good

communication skills. Malignancy is often

very complex in its biological behaviour and

its treatment, and is diffi cult to understand

for lay people; it’s important to be able to

communicate what is going on in clear and

simple terms to patients and their families,

Associate Professor Michael says. Cancer is a

life-changing event, and helping patients and

their families through what may turn out to

be a terminal condition requires patience and

understanding.

Training in medical oncology is overseen by

the Royal Australasian College of Physicians.

Trainees must have an MB BS or equivalent,

and have completed an internship year. Basic

training can begin in the second or third year.

Trainees usually sit their Part 1 written and

oral exams in their fourth year. Advanced

training usually begins in the fourth year

and takes 3 years. The fi rst 2 years of this

consists of core training — gaining experience

working as a registrar within an oncology

team in an accredited major teaching hospital.

The fi nal 12 months can be spent in further

oncology training, or in gaining further

research qualifi cations, such as a PhD, or as

a period spent training in a recognised

overseas centre.

Employment prospects for graduates

— who become Fellows of the RACP — are

excellent. There are currently more positions

available than graduates to fi ll them. The

shortage is most pronounced in Queensland

and New South Wales and in rural parts of

the country. MOGA recently did a workforce

survey (the Australian Medical Oncologist

Workforce Study 2009), which predicted

a shortage of about 150 full-time medical

oncologists nationally over the next 5 years.

This refl ects the increased incidence of cancer

with the ageing population, and the increased

lifespan of cancer patients because of modern

therapy and the greater number of treatment

options available to them.

The salary for a salaried staff member in

a public hospital ranges from $130 000

to $300 000, depending on seniority and

location. An oncologist working mainly as a

VMO may earn in excess of $400 000. For

hospital-based oncologists, the on-call work

is fairly minimal (subject to location), as

after-hours medical emergencies are usually

handled by oncology registrars, although

there are some after-hours ward service duties

in managing inpatients.

“It’s currently a very exciting time to be in

the fi eld”, says Associate Professor Michael.

The treatment of cancer is improving all the

time, survival times are lengthening and cure

rates are going up in cancer generally, and

we’re getting better at managing treatment

side effects, he says. As well, new, specifi cally

targeted therapies are emerging, targeting

patients according to their genetic make-

up (or that of their tumour), particularly in

breast, melanoma, and colorectal cancers. The

fi eld is changing very quickly and Australia

is at the forefront in many areas of cancer

research.

Medical oncology also offers a very broad

scope for academic work, for clinical and

laboratory-based research, and for travel to

and work in major overseas oncology centres.

For more information on MOGA, visithttp://www.moga.org.au/

continued from page C1

M10

1210

-2

Opportunities exist across regional and rural Queensland for senior doctors with skills in the specialities of obstetrics and gynaecology, anaesthesia and emergency medicine.Ideally you would have recent experience in a rural setting and a passion for excellence teamed with a desire to commit to a Queensland community.

Outstanding packages include*:• highly competitive remuneration packages• professional development assistance and leave arrangements • private practice loading (35 - 50 per cent)• motor vehicle and communication packages.

Rural doctors: If you have the skills,Queensland Health has the settings

Fast Track your career today by emailing your curriculum vitae to: ruralmedicalcareers@health.qld.gov.au or telephone +61 1800 000 093

* Su

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ondi

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Recruiting now:• Senior medical officers• Medical officers with

Right of Private Practice• Medical superintendents

with Right of Private Practice

MJA Careers

C6

LOCUMS

Rewarding Locum opportunities...On Call Locums is a leading specialist medical recruitment company providing a professional and personalised service Australia wide. We have been assisting doctors, hospitals and practices with medical placements since 1988. A selection of some of our current positions are listed below:

For further details on these positions and other opportunities available to you please call us: Phone: 02 9363 5300 ext 3 Free call: 1800 256 286Or visit our website: www.ocl.com.au PO BOX K351 Haymarket NSW 1240 Email: info@ocl.com.au Fax: 02 9363 3484

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Contact Kate or Tom for further information Tel 02 9363 5300 option 3

MJA Careers

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MJA Careers

C8

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MJA Careers

NT1

0182

Health Careers & Opportunitiesin the Northern Territory

If you want your career to go places then join Health and Families in the Northern Territory.The challenges and opportunities in health and community care in the Territory are like no other in Australia, from remote Aboriginal health to tropical health and Australia’s National Critical Care and Trauma Response Centre. Continued investments in Aboriginal health, remote health, acute care, child protection and community services offer many opportunities for health professionals who want to be part of making a difference.

ACUTE CARE SERVICES

CARDIOLOGISTSpecialist ClinicianRemuneration Package depending on skills and experience (as per the relevant Medical Offi cers (Northern Territory Public Sector) Workplace Agreement)Employment conditions include professional training allowance, private practice allowance, second roster allowance, salary sacrifi ce, superannuation, 6 weeks recreation leave and annual leave bonusDivision of MedicineCardiology Department – Royal Darwin HospitalTemporary part time contract of up to 2 years available for 0.5 (19 hours per week)

If you are interested in an exciting job with a broad range of clinical experiences, an opportunity to make a difference and the chance to enjoy a tropical lifestyle, then come and join the Cardiology Department of the Royal Darwin Hospital.

Royal Darwin Hospital (RDH) is a 343 bed tertiary Hospital which is designated as the National Critical Care and Trauma Response Centre and a teaching Hospital affi liated with Flinders University. The catchment area is vast, and includes urban communities, regional hospitals and remote Aboriginal communities. The hospital services a population of at least 140,000 with patients also being transferred from northern Western Australia and Timor.

Territory hospitals provide a range of services often not seen in similarly sized hospitals due to the wide range of medical conditions, cross-cultural blend of patients and combination of rural and remote localities. Royal Darwin Hospital has a modern, fully equipped 9 bed coronary care unit which also has facilities for non invasive respiratory support. Diagnostic services include: Exercise stress testing, holter monitoring, transthoracic and trans-esophageal echocardiography, stress echocardiogram, nuclear medicine and diagnostic coronary angiogram. Loop recorders, permanent pacemakers and defi brillators are implanted at RDH.

The Cardiology Department at RDH is a vibrant and growing department. There is a high percentage of cardiovascular and rheumatic heart disease in the young and diverse population contributes to a varied, interesting and satisfying work environment. The workforce currently includes specialist cardiologists, an advanced trainee registrars, general medical registrar, and basic physician trainee resident medical offi cer (RMO).

This vacancy creates an opportunity to join a well established private cardiology service (NT Cardiac Services) which is contracted to the NT Government to provide cardiac diagnostic services including echocardiography and diagnostic coronary angiography, to public patients in the Northern Territory. This combined public and private practice arrangement has been considered unique and has provided a high standard of care for both the public and private sectors.

A successful candidate would be expected to participate in a regular on call roster and ward rounds, student and junior doctor education, clinics at regional hospitals (Alice Springs, Katherine, Gove and Tennant Creek) and out reach Cardiology clinics at remote Aboriginal communities.

Applicants must be eligible for registration for general and/or specialist registration with the Medical Board of Australia together with a Cardiology accredited Fellowship of the Royal Australasian College of Physicians or equivalent specialist overseas qualifi cations.

For further information please contact Jasmine Cowan, Divisional Support Offi cer, Division of Medicine, Royal Darwin Hospital on 08 8922 8888 or email jasmine.cowan@nt.gov.au

Closing date: 28 February 2011

APPLICATION INFORMATIONFor a copy of the job description, please contact Melissa Dexter, Specialist Recruitment on 08 8922 6174 or email melissa.dexter@nt.gov.au Applications, including Curriculum Vitae and details of two contemporary referees should be submitted to melissa.dexter@nt.gov.au

Information on Royal Darwin Hospital and the Department of Health and Families can be obtained from the websites www.royaldarwinhospital.nt.gov.auand www.nt.gov.au/health

Information on the Northern Territory and its great lifestyle is available at www.theterritory.com.au

Note: The preferred or recommended applicant will be required to hold a current Working with Children Clearance notice and undergo a criminal history check. A criminal history will not exclude an applicant from this position unless it is a relevant criminal history.

Department of Health and Families is a Smoke Free Workplace

nt.gov.au/health

D E P A R T M E N T O F H E A L T H A N D F A M I L I E SSPECIALIST APPOINTMENTS

MJA Careers

MJA Careers

CONSULTING ROOMS: SUITES & SESSIONS

Specialist suite in Castle Hill: Lawton House.63m2 approx. Two consult rooms. Good light.

Currently leased: looking for doctor to take over lease.Contact Dr Jennifer Bradford: jennybrd@bigpond.net.au

Rooms with income, for sale, Randwick, NSW.The original owner of these rooms has under-utilized space (over 95 sq metres) plus assured income from a major pathology provider for sale, seeking to see this whole area fully utilized. It would suit at least 3 consulting rooms or professional use other than radiology or additional pathology. It is sited on the first floor of the Wales Medical Centre at 66 High Street Randwick.

For information contact Dr Geoff O’Brien on 0418 288 944 or email pathology@bigpond.com

NEW ZEALAND MEDICAL PLACEMENTS RMOs, Consultants and GPs Auckland Medical Bureau

nationwide

Contact Fran or Alison: PH (0064) 9 377 5903 FAX (0064) 9 377 5902Email: doctors-amb.nz@xtra.co.nz www.doctorjobs.co.nz

OVERSEAS APPOINTMENTS

ENHANCING HUMAN HEALTH

EMBRACING ENDEAVOUR, INNOVATION & COLLABORATION

Applications are invited for the Basic Specialist TrainingProgramme in Emergency Medicine. The Basic SpecialistTraining Programme in Emergency Medicine is a three yearprogramme for medical graduates who wish to pursue acareer in Emergency Medicine in Ireland. The three yearprogramme incorporates 12 months of Emergency Medicine,6 months of Acute Medicine, 6 months of Trauma andOrthopaedics, 6 months of Anaesthesia and Critical Care and6 months of Paediatric Emergency Medicine. All EmergencyDepartments on the programme are recognised for HigherSpecialist Training in Emergency Medicine. Posts will beavailable for all three years of the programme in July 2011.

Applications will only be accepted from medical graduateswho are eligible for registration with the Medical Council bythe below closing date.

Application ProcedureFurther information on the training programme and theapplication procedure is available at www.rcsi.ie/embstEmail: emadministrator@rcsi.ie

Closing date for receipt of applications: Friday 4th February2011.

ROYAL COLLEGE OF SURGEONS IN IRELAND www.rcsi.ie

National Basic SpecialistTraining Programme inEmergency Medicine Starting date: 11th July 2011

Email: search@eqiglobal.com Website: www.eqiglobal.comPO Box 13-419 Christchurch New ZealandPhone +64 3 377 7793 Fax +64 3 377 7765

Chief Medical OfficerNew Zealand

Reporting to the Director-General of Health, and leading approximately 170 staff, the Chief Medical Officer (CMO) will be a key member of the Ministry’s Executive Leadership Team responsible for the provision of advice, information and leadership on clinical matters to Ministers and the health and disability sector nationally. With support from the office of the CMO, the CMO has direct leadership responsibility for public health, mental health, Provider Regulation, Medsafe and the National Radiation Laboratory.

The CMO will provide progressive clinical leadership and strategic direction of the highest quality, supporting the Ministry as a key player in the provision of health advice nationally and as the trusted advisor to Ministers.

The CMO will be a senior registered Medical Practitioner who is nationally respected within the medical profession and will have an understanding of the machinery of government and policy development. The CMO will have extensive professional knowledge of national and international health policy issues, and a demonstrable experience and commitment to improving the quality of clinical services, as well as being an experienced and credible manager at the senior leadership level. They will be a leader, who inspires, communicates, has a passion for improvement and a sense of urgency, earns respect and delivers efficient and effective results.

Family Doctor Wanted in MacauSouthside Medical Centre, located in the commercial heart of Macau, is a purpose built state-of-art polyclinic with its own imaging centre (MRI/CT) and a dedicated laboratory. We are now seeking a family doctor to complement our establishment of GP and specialists. Remuneration package is negotiable. Chinese speaker will be desirable, but not essential.

For further enquiry, please contact Dr Jonathan Kwan, Medical Director, on jonathan.kwan@southside.com.mo , or +853 6295 9993.

MJA Careers

To: Australasian Medical Publishing Co. Pty. Ltd. ACN 000 005 854Locked Bag 3030 Strawberry Hills, NSW 2012. Ph: (02) 9562 6666

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The Guides CasebookCases to AccompanyGuides to the Evaluation ofPermanent ImpairmentFourth Edition

Christopher R. Brigham, MD, Editor

SPECIAL5th Package $360.00*Casebook 2nd

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Guides to the Evaluation of Permanent Impairment (5th) 5th Edition, Disability the US standard

The Guides Casebook (2nd)

The Guides Casebook, 2nd edition,

Guides to the Evaluation of Permanent Impairment (4th)

The Guides Casebook (1st)

Guides from the MJA BookShop!MJABookShop

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MJA Careers

HOSPITAL APPOINTMENTS

- MIGRATION SERVICES - We are happy to announce a new arm to our business:

Wulff Migration Consulting. Our overall goal is to help visa applicants realise their goal of living in Australia. We are now your IMG

One-Stop-Shop combining migration assistance with the recruitment and administrative services of Wulff Medical Consulting.

Visit our website today - http://www.wulffconsulting.com.au/

HOLIDAY LETTINGLuxury, deep-water with jetty,

3-4 br home at Mooloolaba, few minutes’ walk from surf and esplanade, for holiday letting.

Visit www.culbaramooloolaba.com for further information.

MJA Marketplace

Digital Voice Recorder provided

www.meditype.com.au

HOLIDAYS / LIFESTYLE SERVICES

GP OPPORTUNITIES

Box Hill/Doncaster VICVRGP $100/or 65% Nurse support

Pharmacy on site Joanna 0411 410 998

GP OPPORTUNITIES

Apply to be a part ofthe tele-health revolution...

invites GPs with 15 years of experience to join a National Health Advisory Service providing patients with over-the-phone medical advice.

Please apply at www.1300health.net.au or contact 0433 104 649

MJA Careers

MJA Careers

MJA Volume 193 Number 11/12 6/20 December 2010 701

BITES AND STINGS