2024 | Volume 25 | Issue 2

Presidents perspective

Dear colleagues

Tēnā koutou katoa. I’ve recently returned from my second visit to Te Whanganui-a-Tara Wellington in a year. For this trip I was accompanied by the new RACS chief executive, Stephanie Clota.

It was an opportunity to meet face-to-face with the Aotearoa New Zealand-based surgical societies—the New Zealand Orthopaedic Association (NZOA), the New Zealand Association of General Surgeons (NZAGS), the New Zealand Association of Plastic Surgeons (NZAPS), and the New Zealand Society of Otolaryngology Head and Neck Surgery (NZSOHNS).

Our conversations with the societies in AoNZ were very constructive. We have a shared vision—of a surgical education and training system that is high-quality, responsive, sustainable and meets the needs of the profession and the communities we serve on both sides of the Tasman.

Central to our ability to provide this training is our accreditation with the Australian Medical Council (AMC) and Medical Council of New Zealand (MCNZ). Our regulators—the AMC and the MCNZ—jointly have some concerns about the current governance and continuous improvement of surgical education and training delivered by RACS and the societies.

Specifically, they cited governance and structural issues, reminding us that 'RACS, as the accredited organisation, must have clear control and oversight of the training and education programs'. There were no concerns about the quality of the training provided, but with the system delivering and overseeing it.

While the concerns have been longstanding, the regulators have indicated they will only extend our accreditation by six months, to enable us to address their concerns. This takes us up to October 2024 and gives us the opportunity to make all the necessary improvements to show the excellence of our surgical education and training system. I would like to thank the specialty societies for their collaboration in helping to make these necessary adjustments to the system.

As an orthopaedic surgeon, I believe the surgical profession is best served by our unique College-association and society-led training model where the College has oversight over all nine surgical specialties. Any splintering of this model will invite deregulation and a loss of control over the cost and quality of surgical training. Patient care is a team sport and must never underestimate the importance of a multi-disciplinary approach and RACS provides many opportunities in the prevocational training and post Fellowship for professionals to develop skills and knowledge to support this. The surgical profession’s significant lobbying muscle comes from RACS ability to effectively speak to governments in Australia and Aotearoa New Zealand with one voice on issues informed by and affecting nine separate specialities. I would not like to see any weakening of our profession’s collective power. Unity is critical.

I would also like to thank all members who have provided feedback across our various engagement forums over the past few weeks regarding the proposed changes to the College’s governance structure.

Two things have become clear. Firstly, there is broad alignment with the need to address the shortcomings in the College’s current governance structure. Installing a skills-based, profession-led Board to modernise our financial and risk management is essential for our future.

Secondly, it has also become clear through consultation that some of the wording of the proposed amendments to the Constitution was ambiguous and needed refining to deliver better clarify and strengthen surgical leadership. Members have raised legitimate concerns that some of the proposed changes could diminish the role of the Council, which has never been the intention. The core business of RACS will continue to be Council-led. The president will always be the leader of our organisation, the chair of the Board will always be a Fellow and the Board will always be profession-led with a majority of surgeons on the Board at all times.

To enshrine this clarity and ensure it is legally represented, we have instructed our lawyers to redraft the proposed amendments to the Constitution. The process has been paused to allow for continued consultation.

Everything we are doing is aimed at ensuring that the letters ‘FRACS’ after a surgeon’s name continue to represent the highest possible standards. FRACS represents a professional qualification that is globally recognised and associated with quality education and training, innovation, surgical competence, and ethical conduct. This follows a rigorous evaluation process and is consistent with the high standards established and demanded by the College, specialty societies, regulators, health departments, and the community.

Having those five letters after your name demonstrates a commitment to lifelong learning and to a maintenance of surgical standards of the present day, not the day you passed your Fellowship Examination.

The vision of RACS is 'enhancing surgery, embracing innovation', reflecting the inherently dynamic and evolving nature of the profession. The knowledge needed to stay current is ever-changing. This encapsulates the essence of FRACS by recognising the innovative nature of surgery, a quality that we, as Fellows of this College, must all strive to maintain.

Associate Professor Kerin Fielding