AMD eBulletin 29 May 2020

President's Post

As I assume the role of President of the Adult Medicine Division (AMD) of the College I am conscious that I am a custodian, just as our Indigenous peoples of both Australia and Aotearoa New Zealand are custodians of the lands in which we live. As custodian of the role of President, I acknowledge the work of my predecessor, Professor Paul Komesaroff. Paul oversaw a period of planning for the future at the start of his term and this has guided us in our work since, particularly in raising our consciousness of the need to engage with our neighbours and Indigenous fellow country women and men as citizens and custodians of an increasingly fragile world.

So far this year we have been confronted by the ferocity of unprecedented bushfires as a consequence of climate change with all the implications that this has for health, locally and globally. Literally under the cover of the smoke and media attention for the bushfires, pestilence in the form of the global COVID-19 pandemic entered our lives. Both these events will reshape our worldview, and by extension, our response. 

When Harold Macmillan became Britain's Prime Minister, he was asked what would determine his government's course. He replied with Edwardian languor: "Events, dear boy (sic), events". For rest assured, the world as we know it has changed totally and we are at the beginning of a new era. As Lenin once said, “There are decades where nothing happens and weeks where decades happen”. We are living in such a time. For the first time since the introduction of universal health insurance to Australia in 1974, there has been a major shift in policy in so far as it affects frontline healthcare delivery in response to COVID-19, in the form of telehealth which has been introduced almost overnight.

In responding to these two challenges of climate change and the global COVID-19 pandemic, it is time to revisit the issues that the AMD felt they should focus on arising from the last AMD Planning Day, in August 2018. They were:

  • Trainee welfare
  • Model of collaboration (engagement with specialty societies)
  • International and global work
  • Diversity and inclusion
  • Indigenous health and physician workforce.

The next AMD Council Planning Day will be held on Wednesday, 15 July. This will enable us to develop our response to ensure that in the post COVID-19 normal world, the College remains fit-for-purpose and enthusiastically embraces the future. In doing so we particularly recognise the vital role that novel technological capabilities will play in reshaping the clinical world, particularly through the rapid introduction of telehealth. With this comes recognition that new ITC infrastructure will be required as well as new skills; both will ultimately and profoundly reshape the clinical environment.

There is a vital role for the AMD to play in supporting individual clinicians and also in guiding policy and funding frameworks for telehealth and integrated care more generally, to support physicians and particularly their patients and their families. We look to a healthcare service environment which is cognisant of the need for a systemic view and for an integrated system of care built on the principles of co-design with patients and frontline clinicians. This service design process will ultimately need to include social systems as well as healthcare services, be informed by the social determinants of health, and implemented as a collaborative set of activities at a local level.

Trainee wellbeing is important, and the College response to this by way of resolving the disruption to the examination schedules and the consequential impact on career progression through Basic Training and selection into Advanced Training is well underway, supported by close working relationships with both specialty societies and relevant local employers. Support for individual trainees who experience distress and/or hardship as a consequence is also available. Now more than ever, please remember to look after your own health and wellbeing and those of your colleagues. Acts of simple kindness go a long way.

In closing, we mustn't forget the importance of the physician in bringing specialist healthcare services to rural and remote Australia and Aotearoa New Zealand. Hopefully rural training will be better supported in the future than in the past, as telehealth enables a less metrocentric view of the world to emerge and that opportunities for physician training in such rural centres as Alice Springs for example, will be embraced by the College and trainees. 

Don Campbell
President
Adult Medicine Division

AChSHM President’s Post

Following the recent changeover of office bearers in early May, I have taken over the role of AChSHM President. I would like to take this opportunity to thank Associate Professor Catherine O’Connor for her significant contribution as President over the past three years, particularly in relation to Indigenous health.

To introduce myself, I have worked at the Melbourne Sexual Health Centre as the Director now, for nearly 20 years. Before that I worked in water quality and immunisation, but my current job is by far the best. Great staff, great patients and lots of fascinating puzzles to solve. I’m keen to draw on the fabulous talents of the Committee members over the next two years and look forward to working closely with them all. I’d also like to welcome Dr Massimo Giola, our President-elect, who we are very lucky to have on the Committee.

With the start of a new College governance cycle, the Chapter Committee has welcomed two new members: Dr Swaminathan (Sama) Balasubramanian as the Trainee Representative and Dr Jennifer Hayward as the New Zealand Representative. Dr Carole Khaw has also recently joined in her capacity as the Chair of the Training Committee in Sexual Health Medicine. I look forward to working with Sama, Jennifer, Carole and the continuing members over the next two years progressing the work of the Chapter.

The Chapter Committee will next meet on Wednesday, 24 June 2020. If you have any feedback for the Committee please don’t hesitate to contact us through our secretariat at shmed@racp.edu.au.

Professor Kit Fairley
President
Australasian Chapter of Sexual Health Medicine

AChPM President’s Post

Following the biennial changeover in office bearers at the College’s Annual General Meeting in May, I have taken over the role of AChPM President from immediate past-President Professor Greg Crawford. I would like to take this opportunity to sincerely thank Greg on behalf of the Chapter Committee for his significant contribution to the work of the Chapter as President over the past two years. Greg will continue on the Committee for a further two-year term as a General Committee Member.

I would also like to take this opportunity to welcome two new members to the Chapter Committee – Dr Emily Chang as the Paediatrics Representative and Dr Jessica Borbasi as the Trainee Representative. Other continuing members include Associate Professor Peter Poon as President-elect, Associate Professor Leeroy William as the ANZSPM Representative, Dr Gauri Gogna as a General Committee Member and Dr Eswaran Waran as the Chair of Training Committee in Palliative Medicine. I look forward to working with all new and continuing members over the coming two years.

To introduce myself, I am the Director of Palliative Care at Alfred Health in Melbourne, where I have worked for some 20 years. My involvement in College committees extends back to 2004, with this being my second stint on the Chapter Committee. Over this time I have been privileged to work alongside a 'who’s who' of outstanding palliative care physicians and dedicated College staff.

We are in the midst of extraordinary times. As I commence my term as President, there seems to be very little that we can be certain about. However, amongst the uncertainty, the fear and the anxiety, there has also been some positive elements. I am extremely proud of the way that our Fellows have stepped up to advocate for vulnerable patients, produce guidelines to assist our colleagues and ensure that palliative care has been an integral part of the pandemic response in our two countries.

The Chapter Committee will next meet on Friday, 5 June 2020 via videoconference. If you have any feedback or comments, please do not hesitate to contact us through the Chapter secretariat at PallMed@racp.edu.au.

Dr Michelle Gold
President
Australasian Chapter of Palliative Medicine

AChAM President’s Post

As the new President of the Chapter, I would like to take this opportunity to introduce myself and acknowledge the achievements of our immediate past-President Dr Martyn Lloyd-Jones. Martyn provided excellent leadership of the Chapter over the past two years, and together with the other members of the Chapter Committee, I would like to thank Martyn for his contribution to our sector, and look forward to continuing to work with Martyn on issues that affect us.

To introduce myself, I have worked in various clinical, research and management roles in the alcohol and other drug sector for 30 years in Melbourne, London and most recently in Sydney, where I am the Director of Drug and Alcohol Services at South East Sydney Local Health District. During my tenure as President, I hope we will be able to progress the development of an RACP Drug Policy, to re-examine pathways into specialty training, and build closer relationships across the medical Colleges and specialty society related to addiction medicine. My two-year tenure will probably be dominated by COVID-19 related issues in the way we meet and work, and the impact it has on our patients and our services. The Chapter has already demonstrated leadership (in partnership with other professional and consumer organisations), in its advocacy for opioid treatment across the country, but there remains much to be done.      

With the start of the new College governance cycle, the Chapter Committee has welcomed four new members – Dr Carolyn Edmonds as SA/NT Branch Chair, Dr Craig Connelly as WA Branch Chair, Professor John Saunders as NSW/ACT Branch Chair and Dr Clara Dawkins as Trainee Representative. I look forward to working with Carolyn, Craig, John, Clara and the continuing members over the coming two years.

The AChAM Committee will next meet on Friday, 24 July 2020. If you have any feedback, questions or comments for the Committee, please get in touch via our secretariat at AddictionMed@racp.edu.au.

Professor Nicholas Lintzeris 
President 
Australasian Chapter of Addiction Medicine

Updates on Advanced Training Curricula Renewal 

The common standards for Advanced Training curricula have now been finalised.

Thank you to all members who participated in consultation activities on the draft common standards throughout 2019. Your feedback was used to identify the content that is common across the Advanced Training programs and to refine that content.

There is more work to be done to develop appropriate competencies for cultural competence. We will continue development and consultation in this area. 

This year we will also focus on developing the common elements of the learning, teaching and assessment programs that will support the new Advanced Training curricula. 

Some specialties will also start developing their program-specific curriculum content with assistance from the Curriculum Advisory Group and the RACP Curriculum Team.

Expressions of Interest – College Education Committee Chair

The RACP Board is seeking Expressions of Interest for the Chair of the College Education Committee (CEC) which is the peak committee overseeing all education, training and assessment policy and strategy.

The Chair of the CEC will be appointed by an Expression of Interest process with selection and approval by the Board.

As Chair, the successful applicant will need to commit to attending all meetings throughout the year. Meetings are held three times per year face-to-face, with at least two additional teleconference meetings or as required. There will also be a requirement, as Chair, to participate in several assessment and education committees of the College and associated workshops.

Read the full EOI

Apply for the new role of RACP Executive General Manager Strategy and People and Dean of the College

We are recruiting for a strategic leadership role which has been newly created for an RACP Fellow. 
The Executive General Manager Strategy and People and Dean of the College is an integral component of our Senior Leadership Team. The successful applicant will play a significant role in enhancing the strategic impact of the College, representing the greater membership and enhancing the strength of the partnership between members and staff. 

About the role

Reporting to the Chief Executive Officer you will be a leader of the RACP, managing several business areas including the Strategic Coordination Unit, the College Foundation, International Partnerships, the Office of the Dean and People and Culture (formerly HR). 

In this new role you’ll help shape our new direction by delivering a physician’s perspective across the entire College that supports, engages and represents our membership base. You will be a trusted adviser to the Board, its Peak Committees and the CEO. You’ll also play a key role interacting with external stakeholders to evolve the model of healthcare in both Australia and Aotearoa New Zealand. 

This high-profile role is ideal if you are looking to expand your career beyond clinical delivery into organisational leadership and development. 

More information about this critical new role is available in the job advertisement and position description

Eric Susman Prize Nominations

Do you have a colleague who deserves to be recognised for their achievements and contribution to the field of internal medicine? Nominate them for the Eric Susman Prize. Open to both adult medicine and paediatrics, the prize recognises achievements in research, teaching and/or clinical medicine.

Nominations are open from Monday, 15 June to Monday, 31 August 2020.

For further details on these and other prizes, please visit the Foundation webpage

Research Awards and Travel Grants

Don’t miss your chance to apply for funding for 2021 under the following award categories:

The Bushell Travelling Fellowship in Medicine and the Allied Sciences and the Robert and Elizabeth Albert Travel Grant are available to provide support to Fellows and trainees pursuing research endeavours overseas. Applications for Travel Grants will open Monday, 1 June 2020.

There are also other opportunities available in the Research Entry Scholarships, and Research Development Scholarship categories which provide research funding for 2021.

Full details for these opportunities are available on the RACP Foundation webpage.

Trainee Research Awards proceeding in 2020

Applications for Trainee Research Awards open from Wednesday, 1 July to Monday, 31 August 2020. Trainees and new Fellows undertaking post-Fellowship training are encouraged to apply.

The Trainee Research Awards provide a wonderful opportunity to trainees to do an oral presentation of their research at an Australian regional and Aotearoa New Zealand event. The best presenters from each local event are invited to be part of the Research and Innovation stream at the 2021 RACP Congress.

Please send your abstract submissions or enquiries by email to your respective regional RACP office.

AFOEM COVID-19 – Guidance for pregnant healthcare workers now available online

The Australian Government’s Infection Control Expert Group has advised they have endorsed the AFOEM COVID-19 – Guidance for pregnant healthcare workers.

This document is now available online via the RACP COVID-19 webpage under Advice and news > Clinical advice for physicians.

Access the AFOEM COVID-19 – Guidance for pregnant healthcare workers online.

Aotearoa New Zealand – Budget 2020 

On 14 May 2020, the New Zealand Government delivered Budget 2020, Wellbeing Budget: Rebuilding Together. In response, the RACP released two media statements entitled, ‘Doctors say new health funding must prioritise equity’ and ‘Sustained focus on wellbeing essential to support Aotearoa NZ post-COVID-19’.

The first of these releases welcomes the focus and funding in Budget 2020 for the Aotearoa New Zealand health system, including $3.92b over four years for District Health Boards (DHBs) and a one-off boost of $282.5m to address the backlog of elective procedures and hospital appointments. This investment provides an opportunity for equity to be placed at the forefront of decision-making and to improve health outcomes for Māori and Pasifika facing the reality that, in the face of prognostication and health rationing algorithms, they often fare worse in our health system.

As Dr George Laking, Aotearoa New Zealand President said “Right now, health policy is economic policy, it’s social policy and fiscal policy. The investment we make in health as a country will support our social, economic, physical and environmental wellbeing, as Aotearoa recovers and rebuilds through the COVID-19 pandemic”.

The second of these releases focuses on changes made to the social support system and how they influence the social determinants of health – the ‘causes of the causes’ of poor health and wellbeing. The social determinants of health are at the heart of the RACP’s Making It The Norm campaign, which calls for Whānau WellbeingHealthy Housing and Good Work to become the norm in Aotearoa New Zealand.

Dr Laking said that “The Budget places an emphasis, naturally, on jobs and training. The RACP sees work and employment as inextricably linked to housing and whānau wellbeing. We call on the Government to prioritise sustained investment in addressing the social determinants of health. 

“Budget 2020 still only skirts the edges of long-awaited systemic change in social security. We welcome the direction of change but would support the Government going further to support whānau wellbeing.”

This is something that will be ever more important in the continually evolving world of COVID-19 and the resultant economic shock.

Aotearoa New Zealand Policy & Advocacy Committee needs two AMD Fellows

Are you passionate about policy and advocacy in Aotearoa New Zealand and want to contribute to shaping RACP responses to the big issues? Are you keen to work on #MakingItTheNorm and the 2020 Election Statement?

The Aotearoa New Zealand Policy & Advocacy Committee is seeking two AMD Fellows to join.

Learn more and submit EOI

IMJ May 2020 issue available online

The May 2020 issue of the IMJ (Volume 50 Issue 5) is now live on the RACP website and IMJ Wiley.

Key highlights from the issue are:

  • transvaginal mesh
  • clot retrieval therapies for cerebral artery occlusions
  • impact of insurance on patient outcomes
  • upper gastrointestinal bleeding: transfusion strategies  
  • education to improve vancomycin use
  • neutropenic cancer patients in ICU.

The Editor's Choice is a review titled 'Endovascular Clot Retrieval for M2 Segment Middle Cerebral Artery Occlusion: a systematic review and meta-analysis' by Salam Findakly, Julian Maingard, Kevin Phan, Christen D. Barras, Ashu Jhamb, Ronil Chandra, Vincent Thijs, Mark Brooks and Hamed Asadi.

Read IMJ

New Pomegranate podcast: Ep58: Compliance and the Free Market

In this episode we continue the discussion from Episode 56 about medical billing in Australia. Almost 500 million Medicare rebates are processed every year and for the most part these are claimed appropriately, but non-compliant billing could be costing the health system over $2 billion annually. The vast majority of this comes down to misunderstanding of the conditions around MBS items, according to our guest Loryn Einstein of Medical Billing Experts.

Every year the Department of Health shifts its attention onto a different specialty area to look at the statistical spread of claiming behaviour. Practitioners at the top-end of the curve receive warning letters and flagged practitioners who persist with unaccountable billing behaviour will have their practice audited more thoroughly. Finally, they may be referred to the Professional Services Review, a sort of judicial panel made up of clinical peers.

Questions have been raised by professional bodies and lawyers about the sensitivity of these processes to clinical nuance or procedural fairness, and the lack of education available to practitioners. We hear responses to such concerns from the Department of Health.

Finally, we take a look at the huge range of private medical fees in Australia. Loryn Einstein considers how factors like regulation and supply and demand shape this market.

Fellows of the RACP can claim CPD credits via MyCPD for listening to this episode and reading the resources.

Subscribe to Pomegranate Health in Apple iTunesSpotify or any Android podcasting app.

Listen to podcast

No more time to waste: Pregnancy warning labels on alcoholic products 

It has taken over two decades since the first calls for effective and mandatory alcohol pregnancy labelling in Australia for the issue to become subject to government regulation. For well over a decade now the RACP has actively supported this crucial and cost-effective intervention to reduce alcohol-related harm amongst the most vulnerable – children. 

In March 2020, when a new, mandatory evidence-based regime recommended by Food Safety Australia New Zealand (FSANZ) finally seemed within reach, then-RACP President Associate Professor Mark Lane sent a letter of support for the measure to all federal, state and territory Ministers responsible for approving the scheme. Yet again, the approval of best-practice labelling was delayed because of industry pressure.  

As FSANZ concludes another review of the scheme and the Ministers prepare to again debate the benefits of the proposal, the College will once more appeal to the law-makers to endorse this overdue yet vital initiative. With the estimated 75,000 alcohol-exposed pregnancies in Australia each year, the time for decisive government action on effective pregnancy warnings on alcohol products is long past. 

Over June and July, we will be urging the responsible Ministers to approve the labelling scheme as originally recommended by FSANZ. We ask you to support our effort by engaging with RACP media and social media as we continue to advocate for this indisputable gain for alcohol harm reduction across Australia.

Apply for a Digital Health Scholarship 

In partnership with the Australian Digital Health Agency, the RACP are offering digital health scholarships to eligible Australian Fellows and trainees. 

Ten $4,000 scholarships are available for Fellows and trainees familiar with or practicing the use of My Health Record and/or other digital health initiatives in the healthcare environment.

Applicants must:

  • be an RACP Fellow or trainee who resides in Australia
  • be currently employed in a public or private accredited clinical environment
  • have a recent, demonstrated record of adopting various digital health initiatives.

Applications close on Wednesday, 10 June 2020.

For further information and to apply visit the EOI webpage

Australia-wide survey on drug-drug interaction alerts

Do you see drug-drug interaction (DDI) alerts when prescribing? Members have an opportunity to complete a five-minute survey on DDI alerts being run by the University of Sydney and University of New South Wales.  

Access survey

Conference and events

The RACP publishes notices of events and courses as a service to members. Such publication does not constitute endorsement or mandating of any such events or courses.

CODE RED: Overturning Australia's Cholesterol Complacency

Baker Heart and Diabetes Institute and the Parliamentary Friends of Heart and Stroke are pleased to invite RACP members to a virtual event on Wednesday, 10 June 2020, 10am to 11am, that will launch critical new evidence into the burden of Australia's biggest killer – cardiovascular disease.

CODE RED: Overturning Australia's Cholesterol Complacency will reveal new evidence into the significant gaps in care, the challenges faced by Australia living with, and at high-risk, of cardiovasvular disease, as well as those treating them.

The event will feature addresses from leading researchers, clinical experts and Australians living with cardiovascular disease.

RSVP by Wednesday, 3 June 2020 to Georgia Lawson on 0431 973 770 or via email.

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