Left to right: Dr Raffi Qasabian, Dr Angus Gray, A/Prof Laurencia Villalba, James Lockhart,
A/Prof Margaret Schnitzler and Dr Bish Soliman
Chair's Report - December 2023
Dear Colleagues
Surgeons' Evening was held in October at the College Office and was a great evening of celebration, recognising our high achieving surgeons, and we were entertained by the Graham Coupland Medal recipient A/Prof Laurencia Villalba, who delivered her message that surgeons should praise each other more with her witty and fascinating tales!
As surgeons open their emails from MDO’s there are some shocking surprises. Surgeons are questioning the worth of their private practice where indemnity costs are reaching $500,000 per year. Prof Mitch Hansen from Newcastle, who is president of the Neurosurgical Society of Australia achieved a 46% response rate to a questionnaire which indicated that the risk reasoning produced by the MDO’s does not match the percentage cost rise for individual surgeons. A recent survey indicated that 40% of bariatric surgeons will cease private bariatric surgery and this will be another load on public waiting lists. RACS Health Policy and Advocacy Committee, HPAC, chaired by Victorian Urologist Prof Mark Frydenberg, would like to hear from you and will raise this matter with Health Minister Mark Butler.
There is a rush on by NSW Health to utilise federal funding for waiting list reduction surgery and the administrators are not following their own policy, nor acting in a manner that is respectful of the patients and the original surgeon who completed the admission form. This response to a systemic problem is not improving the future. Availability of operating lists and provision of hospital clinics with the necessary equipment close to the patients is required. Surgeons relying on the Lion’s Club to fundraise for basic clinic equipment is far from ideal. A surgical workforce survey in relation to area of surgical need will enable negotiation with NSW Health.
The ANZVS have undertaken a workforce survey and are increasing trainee numbers to provide more surgeons. For more than a decade their registry has tracked procedures across Australia. Their data allows discussions and comparisons with international health systems and has a system to address outliers and competency. This is the value in collecting data. The AOA ASM 2024 from 13-17 October in Brisbane is themed Making Data the Solution and I encourage all surgeons to attend and share their knowledge.
Detailed workforce surveys will delineate where the surgeons who were trained in NSW are working and indeed how many of them are unemployed and forced into an isolated practice in the private sector or jumping from one locum position to another, always hopeful for a permanent position. Is HETI / RACS enabling a pipeline to staff NSW hospitals, with early career medical officers and SET trainees, without the possibility of future employment? There is also the issue of older surgeons maintaining positions while new Fellows wait in the shadows. Ageist as it may seem, perhaps at a particular point a surgeon should share their position with a new Fellow in a positive mentoring relationship. Succession planning for specialised units should take in to account the lead time to produce a surgeon with appropriate skills, the increasing surgical demand, and the likelihood that two surgeons will replace one as family roles and lifestyle preferences demand less hours worked.
Brendan Murphy at his retirement speech noted that we should have more doctors writing policy. As I interact within the areas of NSW Health, I find few surgeons among the networks. Perhaps there is a place for surgeons stepping sideways to ensure the surgical voice is heard, such as in the Emergency Care Institute? The surgical taskforce from which RACS NSW is excluded, exists solely to drive down waiting lists and is not addressing any of the issues raised to RACS NSW. Dr Vikram Puttaswamy, vascular surgeon at Royal North Shore Hospital, is now co-opted on to the NSW State Committee as the trauma representative and will build and chair the trauma committee for NSW as part of the very active RACS National Trauma Committee.
RACS NSW has completed their submission to the Special Commission of Inquiry into Healthcare Funding of NSW Health and we are grateful to all who have engaged to improve the state’s health system. The process will be ongoing until August 2024.
RACS ASC 6-10 May 2024 in AoNZ “Responsibility of a Surgeon” will see us exploring the critical role that surgeons play in not only the surgical system, but in the broader healthcare community and discussing how this responsibility defines our profession and empowers us to elevate the standards of our surgical practice.
