I wish I could applaud this. But what sort of professional organisation waits until its members are actually dying before putting well-being in the radar?

The RACS, RACP etc are sclerotic organisations run by old white men in bow ties (I've met several of them) with no real incentive to improve conditions for trainees. The only way I have seen actual change happen is when junior staff band together and effectively go on strike.

Couldn't agree with you more re RACS, I attended their 'gala ball' at the end of their ACS last year and was sickened by the pomp and bullshit. The (female) RCS president, visiting from England, also appeared weirded out by the pomp (and that the RACS had not had a female president).

Having said that within both organisations there are people who strongly and fiercely advocate for innovation and change, but you are right, they are severely sclerotic (even to the point of RACS making an absolute motza out of their trainees, they've got over $60m in the bank and our exams cost $4,000)

I don't know too much about the RACS etc (father was a radiologist but can't recall him complaining about their equivalent in Aus too much, though it's likely the same).

If you have to be a member of this, and that's government mandated, then them profiting from that arrangement is a blatant monopoly isn't it?

They've been taken to the ACCC previously for anticompetitive behaviour however the focus of that was on nepotism ie the way trainees were selected. The process is more blinded now (to the extent that is possible in a country the size of Aus/NZ with somewhere around ~100 trainees for general surgery a year).

I actually attended the ICOSET conference for 2 days prior to the ACS and there was much discussion over it.

For example, compared to the US situation, where surgical training is run by the universities, surgical accreditation is done by the Board Examinations, and the ACS is essentially just a bit of a union/membership organisation (You can not pass your boards and practice surgery in the US although it cant be good for your insurance), RACS is both trainee selector and accreditor.

There is talk about accreditation being devolved (Macquarie University Hospital is apparently trying to do a course for Neurosurgery) and the Orthopaedics guys left the RACS a few years ago to start their own body (but with similar principles, ie they select trainees and accredit). The MUH model seems interesting but has it's own problems because rumour is they want to charge ~$150k to do their training course. So essentially we have the americanisation of our quaternary training, which I don't agree with.

It's hard to see a real way forward; and even if another organisation came around and said they were going to start training surgeons, they have a couple problems: getting surgeons to say that they are happy to be the Trainers for them and getting hospitals to allow that organisation to train them.

A similar problem exists with the RACGP and it's (my opinion) much better, more nimble and beneficial to the Australian Population Australian College of Rural and Remote Medicine. ACRRM has been steadily building up to become a formidable training force for GPs particularly in rural and remote australia wityh a focus on TRUE generalism, ie GPs that run scope lists, minor surgery, obstetrics and aesthetics. The RACGP has a firm focus on city GPs and City training despite a desperate need for ACRRM/rual generalists. RACGP this year has put the state governments over a barrel and said that trainees must now do X amount of time in a big city, and that rural training is not going to count for as much; with the result that current ACRRM trainees may not make cutoffs in terms of time worked in city practices and fail to achieve their final qualifications. So basically RACGP is making moves to push ACRRM out of the way by introducing changes that benefit it over ACRRM.

all terribly interesting/boring, depending on how much you care about petty politics :)