RACS made a submission to the National Chief Medical Officer at Te Whatu Ora on the draft Guidelines to manage secondary employment – Conflict of Interests.

The Chair of the Aotearoa NZ National Committee wrote to Dame Helen Stokes Lampard, National Chief Medical Officer at Te Whatu Ora, in response to an invitation. The invitation was to comment on and discuss the draft Guidelines to manage secondary employment – Conflict of Interests. 

A significant number of surgeons are simultaneously employed by Te Whatu Ora, affiliated with RACS and ASMS, have employment, contracts, shares in or are members of the NZ Private Surgical Hospitals Association or other private or public entities. For some surgeons, Te Whatu Ora is their ‘secondary employment’ with the roles in private or alternative settings serving as their primary source of income. Consequently, the premise of the guidelines should be duality of paid roles, rather than categorising them as primary and secondary. 

RACS is deeply invested in ensuring the Guidelines accurately reflect this reality of our members’ professional lives—they should be clear, widely available, well understood, and consistently applied. The draft Guidelines primarily addressed the needs and perspective of Te Whatu Ora and did not acknowledge the broader commitments of doctors in working across the public and private healthcare sectors. This was especially true regarding the significant pro bono work provided to Te Whatu Ora by many doctors. 

We submitted the Guidelines as drafted would disadvantage patients, Trainees, and Fellows. They would lead to either:
-- an increase in the number of surgeons opting for primary employment in the private sector, adversely affecting public health services
-- an increase in the hours spent by surgeons dedicated to alternative employment rather than within the public system, particularly in the private sector—impacting public health services

Te Whatu Ora must explicitly acknowledge the growing involvement of surgeons and other medical professionals in outsourced surgical waiting lists and training in private facilities. This includes a provision to supervise registrars in the private sector during their own or outsourced lists.

Our submission also commented on the provisions relating to disclosure of private work, referrals between public and private practice, communication with patients about private treatment, non-poaching and non-solicitation, and access to patient information held by Te Whatu Ora.

MCNZ consultation on regulating doctors performing cosmetic procedures 

RACS made a submission to Te Kaunihera Rata o Aotearoa the Medical Council of New Zealand on a draft revised Statement on doctors performing cosmetic procedures and a draft policy on the training and expertise necessary for doctors to safely perform cosmetic procedures. 

The Chair of the Aotearoa NZ National Committee wrote to the Chair of Te Kaunihera Rata o Aotearoa – Medical Council of New Zealand (MCNZ) in response to a draft revised statement on doctors performing cosmetic procedures and a draft policy on the training and expertise necessary for doctors to safely perform cosmetic procedures. Consultation – Regulating doctors performing cosmetic procedures | Medical Council

RACS is generally supportive of the draft revised statement, which includes a requirement to ensure the doctor has the necessary training, expertise, and experience to safely perform the cosmetic procedures and manage any risk. However, we are concerned the draft Policy on the training and expertise necessary for doctors to safely perform cosmetic procedures, would not fulfil this requirement. For surgeons it references merely having FRACS without stating in an appropriate vocational scope, similarly for dermatologists. The dermatology curriculum spans three years of advanced training after a period as a general medical registrar, which is not comparable to the average three-to-four-year basic surgical training then a further minimum of five years of speciality advanced plastic surgical training (similar for other surgical scopes of practice), with a further one-to-two-year sub-speciality fellowship undertaken by all Fellows of RACS.

We submitted strongly the procedures listed in Category 1 are invasive surgery, which should only be undertaken by those with surgical training. The dermatology pathway does not include adequate training for such invasive procedures beneath the skin and of this complexity. Any procedure requiring anaesthetic involvement falls firmly in the camp of a complex surgical procedure, which requires extensive training and assessment such as provided by RACS’ advanced training programs and achievement of Fellowship status within RACS in appropriate vocational scopes. 

Further, not all surgeons should be able to perform all Category 1 procedures. These should only be undertaken by surgeons who are trained and accredited in the procedures themselves; identification of risk and management of complications; understanding surgical pathology in relevant organ systems; and the management of patient expectations including psycho-social assessment. Specifically, these should only be undertaken by:
-- surgeons who have attained Fellowship in a relevant surgical scope with appropriate sub-specialty skills, post-graduate qualifications and experience, with ongoing Continuing Professional Development, feedback, and accreditation
-- surgeons who are International Medical Graduates (IMGs) vocationally registered in Aotearoa New Zealand, with appropriate surgical sub-specialty skills, post-graduate qualifications and experience, ongoing Continuing Professional Development, feedback, and accreditation 
-- surgical vocational Trainees under supervision of a RACS Fellow or vocationally registered IMG, who is thus responsible for the procedure and its outcomes.

We agreed with consideration of a new category of lower complexity surgeries such as hair transplantation, varicose vein treatment, and dermal fillers, which could be undertaken by dermatologists.

RACS endorses the submission from the New Zealand Association of Plastic Surgeons / Te Kāhui Whakamōhou Kiri.

Read our submission