It is a privilege to write to you for the first time as president of the Royal Australasian College of Surgeons (RACS).

By way of introduction, I am a paediatric surgeon based in Auckland, where I have practised since 1999. My surgical career has taken me through Aotearoa New Zealand, Australia and the United Kingdom, and began in adult general surgery.

I completed my adult training and spent a year as a consultant in Christchurch working as a general surgeon but also taking paediatric surgical call. This made me want to  formally train in Paediatric Surgery with the potential idea of working in both disciplines. My family then spent a year in Perth where I worked as a paediatric surgical Trainee again before heading to Melbourne. We spent 18 months there, took the part 2 exam in Paediatric Surgery and then went to the UK.

While completing my paediatric training I realised this was the career for me. Paediatric Surgery offered more creative solutions, with outcomes that must last a lifetime. Decisions must take account not only the operation itself, but of how a child will grow, develop and move from dependence to independence. It is a challenge I continue to find professionally rewarding and deeply motivating.

What has always given me the greatest satisfaction, however, are the relationships. Looking after children means looking after families. Being trusted to guide them through difficult moments remains one of the real pleasures of my work.

I have spent most of my career at Starship Hospital in Auckland, supported by an outstanding group of clinicians and colleagues. Like any successful surgical service, its strength lies not in buildings or structures but in people. That lesson has shaped my involvement with the College.

I have been actively involved in RACS almost since becoming a Fellow in 1995, primarily through surgical education and training—on the paediatric surgery training committees, as an examiner and later as a Senior Examiner of the Paediatric Speciality Court during the COVID-19 years. I have been involved with many of the skills training programs. A highlight has been working on Operating with Respect (OWR) and subsequently contributing to the Professional Skills Curriculum. Five years ago, I was elected to Council as a specialty representative and have since chaired several committees, including the Prevocational and Education Committee (PSEC), the Committee of Surgical Education and Training (CSET), and most recently the Education Committee as Censor-in-Chief.

I never seriously considered that I would one day become president. I am deeply honoured, truly humbled and will endeavour to repay the faith shown in me. 

Our collective strength
Early on I attended the Younger Fellows Forum. There I realised we all are the College. It is not a faceless organisation. It is thousands of Fellows, Trainees, Specialist International Medical Graduates and staff across Australia and Aotearoa New Zealand, working across different systems and time zones—all committed to surgery, education and patient care. There is formidable expertise and ability within RACS along with a willingness to contribute 

That understanding shapes how I see the role of president.

I do not see myself as the person with all the answers. My role is closer to that of a conductor—leading and representing , but also enabling, facilitating, listening , coordinating and encouraging. My job is to draw on the collective wisdom of the Fellowship and our very capable staff, to overcome the challenges ahead.

The College’s priorities remain unchanged: training, assessment, standards, and advocacy are relevant to our core business. This is why we formed a College and these foundations are as relevant today as they were a century ago. What has changed is the environment in which we work so we must be nimble and able to adapt.

The relationship between surgeons and the communities we serve is evolving. The traditional model of ‘doctor knows best’ has given way to shared decision-making. Patients are partners in their care, bringing their own experiences, values, hopes and fears, along with increasing exposure to information—and misinformation.

As a profession, we must continue to earn trust rather than assume it.

Our continued relevance
I believe reinforcing our social contract is one of the most important challenges we face. If we do not maintain public confidence in our standards and professionalism, others will increasingly seek to regulate on our behalf. We are already seeing this in debates around specialist fees, workforce planning and international medical graduate pathways.

This is why the work of the College matters.

It sets standards. It trains and assesses future surgeons. It advocates for surgical patients. And it brings surgeons together in pursuit of something larger than any one specialty or individual.

That commitment to a unified profession also shapes our ongoing discussions with specialty societies, including the Australian Orthopaedic Association (AOA) and the New Zealand Orthopaedic Association (NZOA). Fragmentation will weaken all parties. We continue to believe that surgeons, patients, communities within the broader health system of both our countries, are best served through a unified profession. Orthopaedic Surgery is an integral part of that profession, and I remain committed to finding solutions that keep us working together within a shared College framework.

Through the Surgical Pathways Strategy, the College is progressing reforms within surgical education. We need to ensure we maintain accreditation, strengthen our relationships with our training partners, improve transparency and reduce duplication. These reforms also aim to address the length of time to enter training, the cost of preparing for training and to encourage and support Trainees from diverse backgrounds. It is clear we also need to work more closely with our hospital and training sites to maintain a conducive learning environment and ensure meaningful employment and services where they are needed. 

Alongside these strategic priorities, I have been encouraged by initiatives that reflect our values in practical ways. One example is the work of the Rural Health Equity Committee in developing rural training hubs alongside speciality partners. Through my outreach work in Northland, I have seen both the challenges and opportunities of delivering surgical care beyond major centres. Efforts such as these help ensure we continue to meet the needs of all our communities.

Our enduring purpose
When I think about the future of the College, I return to an early experience as a medical student in South Africa during the apartheid era , where I spent my elective in Kwa Zulu. I was fascinated by surgery and awed by the technical expertise of the surgeons around me. But what left the deepest impression was not what they did, but who they were.

There is a Māori whakataukī or proverb that captures this:
He tangata, he tangata, he tangata.
It is people, it is people, it is people.

When surgeons come together to learn, teach, debate, mentor and support one another, the purpose of this College becomes clear. We see it in training. We see it in assessment and we see it at scientific meetings. We see it in clinical care in our hospitals and how we treat our patients. Our people are the strength of this College.

As we approach our centenary next year, I am energised by the collective strength of the Fellowship and optimistic about what lies ahead.

The challenges facing surgery are significant. But so too is the capability, commitment and goodwill that exists within this College.

We are the College.

Warm regards
Dr Phil Morreau
President