The President's Message – 15 May 2020
You would have heard much about coronavirus so far, however you need to know what your College is doing about it. The COVID-19 pandemic is being compared to the influenza pandemic of 1918 in terms of infectivity and morbidity in the community. One of our most distinguished Fellows, Sir Frank Macfarlane Burnet estimated that 50 million people died in that original epidemic equating to a loss of 300 million in proportionate terms today. Globally there has been over four million cases of coronavirus recorded with a death rate of 6.8 per cent. These figures are really important, because against these we can measure our own performance.
What has your College done about it? Our COVID-19 expert reference group drawn from specialty societies, advises the Board and provides input into policy development. In addition, if you google COVID-19 RACP you will see an information hub that gives you all the details you need on coronavirus.
Fellows of our College are highly placed in Australian and New Zealand healthcare systems and have influenced decision making through epidemiological predictions, public health policy generation, virus testing techniques and programs, infection control practice and its implementation, as well as trials of pharmaceutical candidates and vaccine development. A real handful for countries our size.
But how have we served the community? Our Fellows and trainees are in the frontline of medical treatment during this pandemic. We provide assistance and protection for risk groups which were previously those with cardio-vascular and respiratory diseases and diabetes. We now know to include males, those who are obese, those with blood group A and a number of other factors we had not previously anticipated.
We have developed and proposed telemedicine programs accepted by Government. These programs have had significant uptake, enabling us to treat those in rural and remote areas as well as those in our local communities. We have campaigned steadfastly for maintenance of high-quality healthcare for those with underlying chronic and complex disease so that they will not miss out. It is known that during previous viral epidemics, as many died from associated comorbidities as died from the viral illness itself.
What about physician training? You, as trainees will have something to talk about on your ward round tomorrow. There are challenges in dealing with uncertainty and isn’t that really part of our training.
I can assure you that Computer Based Testing is on track. It will occur towards the end of next year 2021. There will be no Divisional Clinical Exam this year, and so consideration must be given to progression to Advanced Training. I call on our Training Committees to work with us to show flexibility, to support trainees and help them into Advanced Training, with a contingency that they pass their Clinical Exam within the following 12 months.
We now request that Advanced Training Research Projects are completed. These are an important part of Advanced Training, although in some situations it may be impossible to complete because of the restrictions imposed by the COVID pandemic. You will see further details in relation to training appearing in the coming weeks on our training website.
Please be advised that the COVID Advisory Groups within the College are working very closely with the College Trainees’ Committee who are reflecting your concerns and coming to consensus on timing.
You may well ask finally, how are we as physicians performing? There is no question that longevity has been a strong point in the performance of our healthcare systems. Reflecting that is the fact that while the global death rate from coronavirus is now approaching seven per cent, death rates in our countries are amongst the lowest worldwide being less than 1.8 per cent. I believe that reflects the quality of the healthcare and the dedication of our profession to the welfare of our communities.
But I’d like to know how we can do better. What’s your view? Please email me at firstname.lastname@example.org because you are part of this journey too.
Professor John Wilson AM
At the Annual General Meeting (AGM) held on 4 May 2020, a casual vacancy on the Board of Directors for a term up to the 2021 AGM was created as a result of Dr Jacqueline Small’s election as President-elect of the College.
The Board is seeking applications from members with the skills and capabilities outlined in the Member Director Position Description to join the Board. Expressions of interest are now open for up to one Member Director position until Monday, 15 June 2020.
Australian Indigenous Doctors’ Association (AIDA) is holding bi-weekly Peer Support Forums for Aboriginal and Torres Strait Islander doctors to connect and support one another through the response and management of COVID-19. The forum is held every Tuesday and Friday from 8pm to 9.30pm (AEST).
Sessions will be hosted by AIDA President, Dr Kris Rallah-Baker and will include:
- a brief update from AIDA
- the opportunity to debrief and share how you are managing in the current environment
- a discussion on how the group might individually and collectively strengthen support systems.
Please join in the meeting from your computer, tablet or smartphone.
If you have any questions, please email email@example.com.
We’re continuing to work on the details for provisional progression to Advanced Training (AT) due to the postponement of the Divisional Clinical Exam (DCE). If you were planning to sit the exam this year, you can apply for provisional Advanced Training (pAT) for either later in 2020 or in 2021 if you have:
- completed all other Basic Training requirements, including passing the Divisional Written Examination and
- secured an AT position that starts after the date you would have sat the Clinical Exam in 2020. This position must be in an accredited AT setting, approved by the relevant AT Committee and
- plan to sit the DCE in 2021.
For Basic Trainees currently on the Training Support Pathway:
- all of the above conditions must be met and
- your current supervising committee must recommend advancing to provisional AT.
For all provisionally approved Advanced Trainees, if your attempt at passing the Clinical Exam in 2021 is unsuccessful, any training provisionally approved as 'conditional upon passing the Clinical Examination' will not be accepted as Advanced Training. We are developing guidance to support this process. Trainees will get at least three months' notice of new exam dates.
A reminder to all Advanced Trainees that training requirements including the research project should be completed where possible. As a result of a large number of queries, further clarification of these changes to the research project for all Advanced Trainees, applying for exemptions and information for how it relates to final year Advanced Trainees is available on this webpage.
To provide guidance in using telehealth through COVID-19, you are invited to an interactive webinar to be held on Tuesday, 26 May from 6.30pm to 7.30pm. The North Western Melbourne Primary Health Network has partnered with Katrina Otto, one of Australia’s most experienced digital health and medical software experts to bring you this session.
Amidst the uncertainty of COVID-19, a smooth transition to telehealth offers an unparalleled opportunity to continuously deliver value to patients, whilst overcoming and addressing the challenges of our current healthcare system.
- understanding technology requirements for effective telehealth
- considering practicalities of consent, clinical documentation in a telehealth consultation
- tips from experienced telehealth practitioners
- developing an awareness of electronic transfer of prescriptions.
No disruptions to the RACP Foundation Research Awards 2021
Applications are now open for the RACP Foundation Research Awards providing research funding for 2021. Upwards of 50 awards with a total value of $2.5M are available to Fellows and trainees of the College across Australia and Aotearoa New Zealand in the following categories:
Are you a medical graduate or specialist from outside Australia or Aotearoa New Zealand who intends on furthering your knowledge in medical education and research? You are encouraged to apply for an international grant valued at up to $10,000 each.
There are two international grants available, the College International Grant – Asia Pacific Region (Developing Countries) and the Paediatrics International Grant – Asia Pacific Region. The application must be sponsored by a RACP Fellow and submitted before Friday, 31 July 2020.
Applications for Research Development Scholarships and Travel Grants will open Monday, 1 June 2020. Please refer to the RACP Foundation webpage for information on specific eligibility requirements for each award.
Congratulations to the College Prize recipients
Congratulations to the Fellows and trainees who have been recognised through the College Prizes.
The John Sands Medal 2020: Professor Stephen Clarke
Professor Stephen Clarke is a medical oncologist at Royal North Shore Hospital and Northern Cancer Institute and Professor of Medicine at University of Sydney. He is the immediate Past Chair of the RACP NSW/ACT Regional Committee and has made numerous contributions to the success of the College.
These contributions stem from his lifelong dedication to education, research and wellbeing of trainees and physicians. Professor Clarke was instrumental in the establishment of the Medical Oncology Group of Australia (a specialty craft group of the College) and was the coordinator of medical oncology Advanced Training for several years. More broadly, he served as an executive on the Committee for Physician Training and the Board of Censors where he participated and shaped training programs and College policies.
During his time as Chair of the NSW/ACT Regional Committee, Professor Clarke achieved a wide range of improvements including advocacy on improving physicians’ wellbeing, raising the importance of acute care training in the Basic Training curriculum, and leading the discussions on key health policies such as medicinal cannabis use and chemotherapy prescribing with internal and external stakeholders.
Professor Clarke has always led by example in pursuing excellence in patient care, education and support of colleagues within the College. He is a well-respected physician-scientist and teacher and is now duly recognised with this College Medal for his dedication to these endeavours.
The College Medal 2020: Professor Douglas Bridge
Professor Doug Bridge is a senior medical leader with a reputation for high-quality, sincere, compassionate clinical care. He is a man of great integrity and passion. Proffesor Bridge has exemplified a career based on service dedicated to the health of all people. This has been through his clinical work as one of Australia’s longest serving palliative care physicians, through his commitment to training the next generation of palliative care physicians, and during his role as a volunteer mentor to palliative care clinicians in numerous Asian countries. Professor Bridge has persistently worked to embed spirituality in the curriculum of the RACP and in his advocacy cautioning about the risks if euthanasia and physician assisted suicide are legalised.
He has provided outstanding contribution, being recognised by the award of the Hippocrates Award by the Australian Medical Association (WA) in 2018. He has provided long and dedicated service to the RACP at senior leadership levels in education and is a past President of the Australasian Chapter of Palliative Medicine. Professor Bridge has always strongly believed that our patients are our most important teachers, provided we take the time to listen.
We congratulate our other College Prize recipients:
- RACP International Medal 2020: Dr Kamalini Lokuge OAM
- RACP Medal for Clinical Service in Remote and Rural Areas 2020: Professor Gerard Carroll AM
- The Eric Susman Prize 2019: Professor Merlin Thomas
- RACP Mentor of the Year Award: Dr Sarah Cherian
- RACP Trainee of the Year Award: Dr Hashrul Rashid
Trainee Research Award recipients in the field of Adult Medicine:
- Dr Stephen Bacchi (SA)
- Dr Ben Cailes (VIC)
- Dr Prianka Puri (NSW/ACT)
- Dr Martin Hansen (NT)
- Dr Panchali Kumarasinghe (WA)
- Dr Adam Stewart (QLD)
- Dr Chang-Ho Yoon (NZ)
- Dr Jasmine Zhu (TAS)
Trainee Research Award recipients in the field of Paediatric Medicine:
- Dr Sam Brophy-Williams (WA)
- Dr Emily Cripps (TAS)
- Dr Alison Freeth (NSW/ACT)
- Dr Matthew Lynch (NT)
- Dr Sarah Primhak (NZ)
- Dr Robyn Silcock (QLD)
- Dr Eva Sudbury (VIC)
The COVID-19 Health and Disability System Response Plan establishes a framework to prepare for and manage the national response to the outbreak of novel coronavirus disease 2019 (COVID-19) in Aotearoa New Zealand. It is aimed primarily at the health and disability sector but includes some components relevant to other agencies and sectors.
This Plan is derived from the framework provided by the New Zealand Influenza Pandemic Plan (2017) and relevant information from other sources. We are currently pursuing a version of an elimination strategy that seeks to eradicate or minimise cases of COVID-19 from New Zealand to a level that is manageable by the health system, until a vaccine becomes available to achieve population-level immunity.
Do you have a compelling story about how the living guidelines are impacting your clinical community and patients? The National COVID-19 Clinical Evidence Taskforce would love to hear from you.
If you have been using the guidelines to inform clinical practice and treatment decisions and would like to be involved, please email us.
In 2020, National Palliative Care Week (NPCW) will be held from Sunday, 24 May to Saturday, 30 May 2020. The theme of the week is ‘Palliative Care…It’s more than you think’. The key message of the week is that palliative care can help people with life-limiting illnesses to live as well as possible, for as long as possible, by supporting their physical, emotional, spiritual and social needs.
The RACP’s updated Evolve list of low-value practices in palliative medicine reflects the multi-faceted nature of good palliative care. The recommendations, which aim to drive high-value and excellence in palliative medicine, span physical and mental care and cover:
- the importance of early, effective communication with patients
- improved non-pharmaceutical treatment of delirium
- limiting overuse of oxygen therapy
- targeting bereavement services at the loved ones experiencing complicated grief
- reducing harmful polypharmacy through drug regime reviews.
NPCW 2020 aims to spark important conversations about the benefits of quality palliative care and celebrate the dedication of those working and volunteering in palliative care across Australia. While the COVID-19 restrictions have forced the cancellation of many physical events, there will be other ways to engage with medical professionals and community. See Palliative Care Australia's events page for more information.
The first independent evaluation of the minimum unit pricing (MUP) of alcohol in the Northern Territory (NT) has demonstrated that the intervention is working after it showed that:
- alcohol-related assaults had dropped by 23 per cent across the NT in 2018-19 compared to the same period in the previous year
- emergency department attendances declined by 17.3 per cent within the same period
- there were meaningful reductions in child protection notifications, protection orders and out-of-home care cases, alcohol-related road traffic crashes and alcohol-related ambulance attendances.
While MUP is only one of several interventions introduced by the NT Government to reduce alcohol-related harm in the NT, positive results from Darwin, where the MUP has been implemented without the additional support from Police Auxiliary Liquor Inspectors, indicate that the policy is achieving intended outcomes.
The College has been an ongoing supporter of a MUP on alcohol in the NT and will continue advocating for its implementation across Australia. For more information on this, please read this webpage and our Submission to Northern Territory Alcohol Policies and Legislation Review Issues Paper.
You are invited to contribute comments to the College submission to the Royal Commission into Aged Care Quality and Safety on the impact of the coronavirus (COVID-19) on the aged care sector. The terms of this part of the Commission’s enquiry are non-specific but will help you to more fully understand the impact of COVID-19. The College’s December 2019 submission to the wider enquiry into aged care is available on the RACP website. Please send your comments or enquiries to RACPconsult@racp.edu.au by Monday, 1 June 2020.
The Commonwealth Department of Health recently developed resources about COVID-19 for people with a disability. The website provides a simple overview of issues relating to people with a disability, including the Management and Operational Plan for People with Disability.
In her capacity as President of the Australian Association of Disability Medicine, President-elect Dr Jacki Small was part of the advisory committee which developed the resources and which has continued meeting to oversee the implementation of the plan.
The COVID-19 Plan for people with a disability outlines how key activities will operate and how the Australian public can support the national response. The following information is provided in the plan:
- what we know about the disease and the outbreak
- what sort of risk COVID‐19 represents
- what the Australian Government health sector will be doing to respond
- how the Government’s response will affect people
- what people can do to contribute
- how people can manage their own risk, the risk to their families and their communities.
We are working hard to implement methods so supervisors can continue to participate in any scheduled Supervisor Professional Development Program (SPDP) workshops. For the time being, we are only adjusting our May and June workshops from face-to-face to individual Zoom workshops, where possible. We will be in touch with anyone who is booked in for a workshop during this time and will continue to monitor the COVID-19 situation and make adjustments as needed.
As a result of the demands on supervisor’s time as well as our capacity to offer workshops throughout the pandemic, the College Education Committee (CEC) have approved a new deadline for supervisors to have completed their first workshop by the end of December 2021. All supervisors must still complete the full program by the end of 2022.
Find out more
The Fellowship Committee is a peak RACP Board Committee that works closely with all College bodies to support enhanced services and engagement for members. Committee members are responsible for submitting recommendations to the Board on important issues that will impact all members of the College.
The Committee is responsible for:
- management of the College elections and generic rules and guidelines as appropriate
- overseeing of the continued development of member services
- developing processes to support the pastoral care needs of Fellows
- collecting surveys to assess the engagement of members and their satisfaction with College services
- maintaining the College’s cultural assets, including the History of Medicine Library
- overseeing College wide celebrations and events including Congress and Ceremony
- awarding Honorary Fellowships, College Awards and Medals.
The Committee meets four times a year. All meetings will be held via video-conference until further notice. The term of office is for two years, with the option to renew for a further two terms.
Read the Fellowship Committee By-laws
The Clinical Genomics for Physicians online course introduces physicians in Australia and Aotearoa New Zealand to the emerging field of clinical genomics. It aims to enable physicians to use genomics appropriately in their practice and engage with its evidence-based integration into the broader health system. It features video interviews with physicians already using genomics, interactive tools, quizzes and case studies.
The course covers:
- human genome structure and function
- genome sequencing and testing process
- applications of genomic testing in healthcare
- discussing genomic testing and results with patients and their families
- ordering a genomic test or referring to genetics services
- interpreting a genomic report
- ethical, legal and social issues.
RACP Online Learning Resources are free for RACP members and count towards Continuing Professional Development (CPD) requirements.
So you can still learn from each other, engage with experts and your peers and contribute to the conversation we are now preparing to deliver Congress online. RACP Congress 2020 Balancing Medical Science with Humanity online program will explore the theme and deliver shared sessions and selected stream sessions for you to access from your computer or device.
You will be able to watch orations, interact with experts through webinars and listen and contribute to panel discussions via podcasts.
Details about the sessions and how you can access the program will be announced soon.
Our RACP Support Program partners, Converge International, have released their latest edition of Flourish, their online health and wellbeing eMagazine. Converge International manage our free 24/7 support hotline for members and staff.
Articles this month include:
- The Positivity Pandemic
- Tips for Home Schooling
- Staying Active at Home During COVID-19
- and the special free download of our Children’s coronavirus storybook Iris and the Virus.
Read Flourish Magazine
To support the implementation of Evolve and Choosing Wisely recommendations in clinical practice, we have launched two case studies depicting clinical scenarios in which recommendations on reducing low-value care apply. These case studies explore a clinical scenario based on one of the Evolve recommendations on low-value care.
Evolve is seeking enthusiastic Fellows and trainees to partner with us in developing case studies for more specialties. The aim of the case studies is to support Fellows and trainees to build an understanding of low-value care within their specialty and act as a tool for clinical educators and supervisors. Email firstname.lastname@example.org to get involved.
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 two billion dollars 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 speciality 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.
RACP Fellows can claim CPD credits via MyCPD for listening to this episode and reading the resources below. To be among the first to find out about new podcast episodes, subscribe to Pomegranate Health in Apple Podcasts, Spotify, any Android podcasting app or our email alerts list.
The challenges of COVID-19 have highlighted that there’s no better time to think about the way digital health technologies can support us in providing care to our patients. Telehealth is becoming the new ‘normal’, and physicians are looking at how they can continue to provide high quality care in a virtual environment.
The Australian Digital Health Agency is seeing emerging best practice in Telehealth, which goes beyond simply conducting a consultation over the phone or via video link. Rather, it integrates better use of data and digital tools into the assessment and management of our patients. Digital tools including electronic prescribing, secure messaging and the My Health Record system can all provide more efficient Telehealth based care in our clinical practice environments.
Work has now commenced on a ‘Specialist Digital Health Toolkit’ in collaboration with the RACP, which will be tailored to the needs of physicians and support you and your practice teams to get the most out of these digital health tools. We’ll keep you updated as that develops.
Changes have been made to Commonwealth legislation to recognise an electronic prescription as a legal form to allow medicine supply. This provides prescribers and patients with an alternative to paper prescriptions. Paper prescriptions will still be available.
Electronic prescribing will not fundamentally change existing prescribing and dispensing processes. It provides patients with greater choice and patients can still choose which pharmacy they attend to fill their prescription.
Under the Australian Government’s National Health Plan for COVID-19, electronic prescriptions are now being fast-tracked to support telehealth and allow patients to receive vital healthcare services while maintaining physical distancing and, where necessary, isolation.
A significant amount of work has already been done to ensure that necessary upgrades to both pharmacy and prescriber software can be done quickly, and electronic prescriptions will be progressively rolled out from May.
Electronic prescriptions are an alternative to paper prescriptions which will allow people convenient access to their medicines and will lessen the risk of infection being spread in general practice waiting rooms and at community pharmacies. Additional information for prescribers can be found online.
My Health Record
There are now more than 22 million Australians with a My Health Record, and 60 per cent of these records contain valuable information, such as medicines lists, allergies, discharge summaries, GP created Shared Health Summaries, pathology and radiology results and immunisations. This means medical specialists will be able to view online information from GPs, pharmacists, private and public hospitals and a range of other healthcare providers, as well as upload their own reports for GPs, other healthcare providers and their patients to view.
With 94 per cent of public hospital beds connected to the My Health Record system, medical specialists are also able to view My Health Record documents for patients in the hospital setting. The Australian Digital Health Agency has already undertaken work with the Australian Commission on Safety and Quality in Health Care (ACSQHC) and The Australasian College for Emergency Medicine (ACEM) to design a tailored guide for Emergency Medicine clinicians.
Specialist software upgrades
To ensure medical specialists also have access to more usable clinical software that supports your ability to use the range of features that My Health Record now offers, work is underway with nine software products that will soon be released to integrate specialists’ clinical information systems to the My Health Record system.
Software developers are currently integrating key functionalities for specialists to upload specialist letters as a seamless part of their existing clinical workflow and enhancing the ability to access relevant information in a My Health Record.
The enhanced software products listed below will be released to market in 2020/21. Developers engaged include Best Practice VIP.NET, Clinic to Cloud, Clinical Computers, Genie – both on premises and Gentu SaaS products, Intrahealth, Medical Objects, Mouse Soft, S4S, Zedmed.
The main enhancements to the clinical information systems are:
- presentation of the medicines view
- presentation of the pathology view
- presentation of the diagnostic imaging view
- seamless upload of specialist letters integrated into clinical workflow
- seamless upload of prescription records integrated into clinical workflow (except for systems that do not have a prescribing module)
- supports SHA-1 and SHA-2 certificates.
Digital health education resources designed for physicians
The Australian Digital Health Agency has also developed some digital health education resources together with the RACP. These are available to you as a RACP member, which you can find online on the RACP eLearning Portal. The My Health Record Curated Collection contains links to Australian Digital Health Agency created materials such as factsheets, user guides and websites, as well as RACP webinar recordings. RACP members are also eligible for CPD credits for accessing this collection.
We’ll continue to engage with medical specialists and your peak bodies, to provide you with support and advice about getting the most out of the range of digital health tools available to help you in providing high quality care to your patients.
Professor Meredith Makeham
Chief Medical Adviser, Australian Digital Health Agency
About the Australian Digital Health Agency
The Agency is tasked with improving health outcomes for all Australians through the delivery of digital healthcare systems, and implementing Australia’s National Digital Health Strategy – Safe, Seamless, and Secure: evolving health and care to meet the needs of modern Australia in collaboration with partners across the community. The Agency is the System Operator of My Health Record, and provides leadership, coordination, and delivery of a collaborative and innovative approach to utilising technology to support and enhance a clinically safe and connected national health system. These improvements will give individuals more control of their health and their health information, and support healthcare providers to deliver informed healthcare through access to current clinical and treatment information.
For many of us, working from home is another challenge we must deal with as a result of the COVID-19 outbreak. Although many Australians have already experienced the rewards and challenges of having to work remotely, if you’re new to the full-time couch commute, now’s the time to set up healthy habits.
Discover these quick tips from HCF, our health insurance provider on working from home:
- Regularly get up, stretch and move around. Sitting less and moving more helps reduce a raft of health risks.
- Prioritise healthy sleep. For a start, keep electronic devices out of the bedroom.
- Stick to the same work hours as you usually would. Start, have lunch and finish at your regular times.
- Give yourself three action items for each day so that when you log off, you have a clear view of what you’ve achieved.
- Consider setting up a buddy system with a colleague and checking in with one another as needed.
- Take advantage of the mental health resources available to you through your employer; from organisations like Lifeline, Headspace, Beyond Blue; or through your GP.
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