The President's Message – 10 May 2019

We held a fantastic Congress in Auckland this week. During my time there I received some questions from members about the impact of the Australian Charities and Not-for-Profit Commission (ACNC) investigation of the College.

ACNC Investigation

Some Fellows have expressed concern to the Board about the scope of the investigation and impact on work being done on committees, or other Fellow led work throughout the College.

Our College relies on the generosity of thousands of Fellows who contribute their time pro-bono across numerous committees, setting, supervising and marking examinations, and leading our Education Renewal program. Those concerns are understandable.

The focus of the ACNC investigation is not on the work of those committees leading important College work in the areas of education, learning and assessment, policy and advocacy, membership, research, international and professional development across our two countries.

These efforts and interests continue as usual, as does our annual program of examinations, training, induction to Fellowship and site accreditation.

The College is working together with the ACNC in relation to Board governance and culture. I look forward to working with them for the benefit of all members by improving the performance of the Board. I undertake to share further details from the Commission with you once we can do so.

Director resignation

Dr Alice Grey has resigned from her position as Trainee Director on the board. Dr Grey made this decision some time ago having experienced a challenging board environment with a demanding program of activity in the first year of the current board’s term.

A replacement Trainee Director will be appointed to ensure that the trainee voice continues to be heard at board level. We thank Alice for her service to the College as a Director and wish her all the best for the future.

Congress 2019

I’ve received enthusiastic feedback from many delegates who recently attended Congress 2019. Both local and international attendees were inspired by Sir Mason Durie’s keynote address onTikanga Māori – the Māori way of doing things. Gaining new perspectives to improve patient outcomes was a major focus of Congress.

Sir Mason talked about the Māori approach to health and wellbeing. He spoke about everything being interconnected; taha tinana (our bodies), taha hinengaro (our minds), Taha whānau (our relationships) and taha wairua (our meaning and purpose). Eighty-one per cent of attendees said they valued unique this perspective.

Our First 1,000 Days statement and session was also enthusiastically received. It highlighted that increasingly in future we’re going to need to identify medical and social interventions that prevent disease, rather than ones which treat disease after the fact.

We heard a powerful Cottrell Memorial Oration from Monash University’s Professor Suresh Sundram titled `A Bitter Harvest – The health consequences of seeking asylum in Australia’.

Our closing plenary `Physician heal thyself’ explored different perspectives on doctor’s health and wellbeing from six speakers ranging from trainees through to senior physicians.

The overwhelming conclusion was regardless of their level of experience, no physician can provide optimal healthcare if they’re running themselves ragged.

Our inaugural Fringe Festival showcased a diverse range of physician art, music and many other activities. It was enjoyed by those who took part, with 86 per cent rating it as excellent and wanting it to continue at future Congresses.

We’re already planning for Congress 2020 in Melbourne and I hope to see you there.

Kind regards,

Associate Professor Mark Lane
RACP President
 

Conversations with the Board – February and May

On the eve of our first Board meeting for 2019, RACP Board Directors held another Conversation with the Board event, this time at The Royal Melbourne Children’s Hospital on Thursday, 28 February.

We aim to meet trainees and Fellows where they work and talk about issues that are important to them. At this meeting we sat around a table and discussed some challenging topics including gender equity, how we can make it easier for members to participate in College business (especially those with carer responsibilities), diversity, the pressure members are experiencing in the work place – particularly regarding training and how we can collectively address bullying.

I thank the members who joined us for a frank and open discussion.

Board Directors also spent some time at the RACP booth at this week’s RACP Congress in Auckland and chatted with members over morning or afternoon tea – thank you to everyone who took the time to come and have a chat.

Associate Professor Mark Lane
RACP President

We heard there is a growing desire by our members to address gender equity in the College and in physician practice. We discussed how the College might tackle this, such as: demonstrating gender, ethnic and age diversity in the composition of the Board and College committees, committing to measuring and reporting on this and making our community more aware of systemic bias. It was felt these would be ways in which our College could reflect the gender and ethnic diversity of our trainee and physician community.

To demonstrate our commitment to addressing gender equity, an informal Women in Medicine group met at Congress 2018 and was continued in Congress 2019.  We are exploring ways to support and collect more detailed data on the diversity of our members.

We heard that the ways in which our committees conduct business meetings can prevent members with young families with personal responsibilities from participating (e.g. interstate travel). We also heard about the frustration some members experience with the time it takes for a program of College work to come to fruition and this can be a reason not to get involved.

By increasing the use of tele/video conferencing for meetings, travel time has been reduced. We are also undertaking quantitative benchmarking, comparing our operations with similar organisations, and exploring ways to reduce demand on Fellows’ and trainees’ time.

We acknowledge that committee membership needs to be productive and valuable for volunteers, and that sometimes it can feel like progress is slow. Some areas of our work are inherently complex and require extensive consultation and careful long-term planning.

We heard concern regarding trainee numbers, capacity to train and we were asked what the College’s strategy is to address this.

We recognise Fellows are being asked to do more work within our health systems and increasing the number of trainees is another pressure point for Fellows and trainees alike. We have been working for some years on a solution for managing selection into training. Predicting future need for health services and matching training to demand is difficult; demand is modelled at up to twenty-year intervals by the Commonwealth Government in Australia and is particularly challenging in relation to the physician workforce. We participate in national strategic planning forums that look at available data and attempt to forecast medical workforce demand by specialty groups. We hope to achieve more robust modelling through our continuing work with the government which will inform our understanding of the demand for the physician workforce and implications for training capacity.

We also continually review our training site accreditation standards to provide guidelines for safe training. This is the primary influence we can offer at present.

We heard that productivity demand on physicians from health departments coupled with growing service demand is affecting their capacity to train, and there are growing concerns around the system’s ability to deliver the clinical exam. Trainees continue to question the value for money they receive for their training fees.

The unique value of work-based training needs greater protection, and greater recognition by employers. Relying more on Entrustable Professional Activities (EPAs) to measure competency should change the perception of training as it will link assessment more directly to the work trainees do daily. We will be able to explore how our assessments might rely less on an exam format. As our education renewal program rolls out, we will work with health department stakeholders to advocate for the capacity to train to be safeguarded.

We heard about the growing impact of burnout on the medical workforce. Members discussed the need for doctors to “self-change” and personally own the required culture change. They also expressed the need for the Board to advocate and set the tone for all members and committees, with zero tolerance for bullying amongst members whether in College bodies or in the work place.

Work is already underway through the Health and Wellbeing Strategic Roadmap, and the inaugural 2018 Physician Trainee and Educator Survey results raise issues for employers as well as us that require addressing. Results will be released in June 2019

We heard about ongoing concerns related to the Computer Based Exam failure and the Ferrier Hodgson Report. Some spoke of the importance of the findings and the relevance for the College as a whole.

We acknowledge these concerns and we have accepted all of the recommendations made by Ferrier Hodgson and are already implementing many of the them.
 

Election commitments from both major Australian political parties on child health

On 2 May 2019, The Australian Labor Party announced a package of health measures that they will implement if elected on 18 May. These align well with the recommendations of our position statement on 'Early childhood: The importance of the Early Years'  which was launched at Congress 2019 in Auckland earlier this week. 

Labor’s package includes taking up the RACP’s recommendation for the creation of a Commonwealth Chief Paediatrician, establishment of a whole-of-government taskforce on child health and development of a national first 1,000 days program.

On 8 May the Liberal National Party Coalition also announced funding of $4 million over four years for implementation of a new National Child Health Action Plan – the development of the plan was announced by Minister Hunt at the RACP’s August 2018 forum at Parliament House.

The RACP's advocacy has undoubtedly had an impact on both major parties making further commitments to child health. We look forward to the New Zealand Government's response to our early childhood position statement in the budget on 30 May 2019. Thanks go to PPAC’s Chair, Dr Pat Tuohy and members of the working group for developing this important position statement.

National Dust Diseases Registry

Joint RACP/AFOEM/TSANZ advocacy leads to election commitment from both major parties to fund a National Dust Diseases Taskforce and a National Dust Diseases Registry to tackle the epidemic of accelerated silicosis amongst stonemasons.

Both major parties contesting the Australian Federal election have now committed to establishing and funding a National Dust Diseases Taskforce and a National Dust Diseases Register to tackle the epidemic of accelerated silicosis amongst stonemasons. This is the result of ongoing advocacy from the RACP and the Australasian Faculty of Occupational and Environmental Medicine's (AFOEM) undertaken jointly with the Thoracic Society of Australia and New Zealand (TSANZ) for some months now. More recently, the Australian Institute of Occupational Hygienists, the Australian New Zealand Society of Occupational Medicine (ANZSOM) and the Lung Foundation have also joined with us to advocate for strong action on silicosis. We have welcomed these commitments from both major parties and will continue to work closely with them to effectively implement these measures.

Launch of the Employment, Poverty and Health Statement of Principles

Dr David Beaumont, Chair of the AFOEM-led Reference Group on Employment, Poverty and Health launched the RACP Employment, Poverty and Health Statement of Principles and accompanying Evidence Review at RACP Congress 2019. The Statement of Principles is a principles-based guide for healthcare provision that focuses on actions that doctors can undertake to promote safe, healthy work and to have the greatest impact on social determinants of health. The accompanying Evidence Review paper lays out the basis of research which supports the actions and strategies put forward in the Statement of Principles. 

 

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