Who would have thought the Coalition would elect an ex-unionist as leader as soon as they entered opposition? After all that fuss about Labor’s front bench being stacked with unionists!

Dr Nelson may not fit some people’s perception of a traditional unionist, but as a former leader of the national doctors’ union, the Australian Medical Association (AMA), that’s just what he is (or was). The AMA doesn’t like to promote itself as a union, but when it comes to advocating for the terms and conditions of its members, it fits fairly firmly in that category. (See Encarta Dictionary for the definition: “an organisation … that is set up to serve and advance its members’ interests in terms of wages, benefits, and working hours and conditions”.)

Well, yes.

And as it is this union that has had so much influence in the formulation of health policy under the former Coalition government, it will be very interesting to see how they go negotiating with the Labor government. Sure, Nicola Roxon is claiming to be more than a “health minister for doctors”, a less than veiled reference to the influence wielded by the AMA with her predecessor Tony Abbott; but what will the reality be?

And why should anything be any different?

Well, consider for a moment the statistics: The health profession in Australia is made up of: 250,000 nurses (yes, that’s right, a quarter of a million), 46,000 medical practitioners (includes GPs and specialists); 31,000 allied health professionals; and 23,000 dentists and oral health professionals.

Given the relative numbers, why has the former government been listening to doctors over the other health professions? Well it’s a good question and one that has been puzzling many. One answer is that the former government, like its prime minister, was rooted in the past; a past where doctors prevailed as the decision makers in health care and, due to the power afforded them in this country, negotiated a stranglehold on the pipeline of public funds for out-of-hospital and primary care services.

But times, and the community, and its health needs, have moved on. The public are now likely to feel comfortable seeking an opinion from a chiropractor for their back pain; to consult a naturopath for a chronic condition; to consider the maternal and child health nurse as the first port of call for developmental advice regarding their baby’s growth.

A range of other health care providers must be utilised (and that means publicly funded) if we are to meet the 21st century health needs of the community. But loosening the doctors’ hold on the purse strings has been difficult. Consider the difficult introduction of expanded practice roles such as that of nurse practitioners in Australia. For despite producing exemplary health care outcomes, despite operating within one of the most rigorously evaluated frameworks in the world, twelve years after the role was introduced, there are less than 300 nurse practitioner positions available in Australia for these expert and highly skilled clinicians.

Why? Well, one of the loudest voices opposing their introduction has been that of doctors (not all groups), but the AMA in particular has been vociferous in their opposition. The arguments are baseless, are not supported by evidence, and serve only to deny (most) Australians access to what constitutes a high quality health care service provider.

Put simply, the Australian health sector has been held captive by a few vested interests who, in clinging to a medically oriented system, reinforced the outdated and hierarchical system they benefit from controlling.

But this government, and the health sector, must move on.

Labor claims to be committed to delivering a health system that will focus on wellness, not illness, and to reinvigorating primary health care to address the explosion of chronic illness and keep people out of hospital by keeping them well. It’s not rocket science, but it needs to happen. An ageing population and longer life expectancy are putting additional pressure on the health budget and, with one of the highest rates of admission to hospital in the world, Australia can’t afford not to act. Consulting with the broadest possible range of stakeholders, including the community, will be vital to getting the best outcomes possible from reform.

But will Labor be able keep the views of doctors in perspective?

We should all hope so. The influence of the AMA may well be somewhat blunted given that they have hardly been supportive of Labor policy in the past, and – in sharp contrast to most other health care stakeholders in the country – were claiming the superiority of Coalition health policies to the final day of the election campaign.

Health care and the community will be better off if this new government combines policy development with broad consultation processes. And listening to all the health care providers is a good place to start.