The Beginning of the End?

Abstract

The passing of RACS at 100 years is not to be celebrated as a life well lived but rather a tragic death of an organisation with immense promise. Born in 1927 with two parents from New Zealand and Australia, the Royal Australasian College of Surgeons (RACS) was created to set standards and provide training for medical practitioners wanting to pursue a surgical career. It was always intended to cover the breadth of surgical practice. Its admission process allowed overseas qualifications to be recognised, along with Australian and New Zealand university postgraduate surgical qualifications, wartime training and ultimately developed its own unique Fellowship.

It gave birth to a College of Anaesthetists, allowed ophthalmology to become independent, survived the Australian Medical Council (AMC) scrutiny, followed shortly after by the Australian Competition and Consumer Commission (ACCC) concerns of monopolising surgical training [1]. It has had to deal with the introduction of Medicare, fee gouging, Government short-term goals, potential College financial ruin, private hospital training, bullying and sexual harassment and unscrupulous surgical practices by surgeons.

The glue that holds RACS together is the ‘craft of surgery’ which is focussed on the best care for surgical patients. There can be no quarter given for financial greed, personal aggrandisement or denigrating surgical colleagues. Standing up to Government, the media, rogue surgeons and conservative mindsets is not easy. For medical colleges generally, and RACS in particular, failure to withstand assault, ill-considered change at the expense of patient care and surgical reform is why the College was created.

Fellowship of the Royal Australasian College of Surgeons (FRACS) took over a generation to create and, while not perfect, stands as one of the most highly regarded badges of surgical training and practice on the planet. When faced with a patient suffering from a life-threatening condition, the surgical team rises to the occasion to develop a strategy that solves the clinical problem. We are very talented at developing new approaches and strategies to improve patient care. Unfortunately, when it comes to RACS, instead of looking for solutions that provide both nations with an excellent surgical organisation focussed on surgical patient care, it is struggling to hold Fellows and some craft groups to task and to uphold professionalism. Some factions do not care enough about the profession and decide to weaken the structure that has delivered outstanding leadership and play into the hands of those who would welcome a divided faction-riddled cabal of surgeons. If the College is to be a champion of advocacy, training and standards in the future, it needs to stand up and bring into line those who would bite the hand that feeds because they don't care, don't understand, or focus on their material gain. Most just want to be the best surgeon possible, working in a safe, innovative, caring environment. Unless these silent FRACS talk to their colleagues in tea rooms, at conferences, on podcasts and social media, what has been taken for granted will be lost forever.

We teach our trainees and junior colleagues to be resilient, adaptable and committed. These skills could be used to reform RACS into an organisation fit for surgeons, the society we serve and ready for the next 100 years, rather than destroying something a century in the making. No matter if you are working in a rural setting, running a university department of surgery, charging egregious fees in a metropolitan private hospital or providing selfless, committed care to a community, RACS made it possible.

Consider action rather than floral tributes.

Guy Maddern: conceptualization, writing – original draft, writing – review and editing.

The author declares no conflicts of interest.

Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.