New RACP president pledges two changes for specialists

Dr Jacqueline Small. Source: RACP

Making the RACP more relevant for specialists and growing its voice in Canberra will be the top priorities for the next two years, its new president says.

Dr Jacqueline Small says she is focussed on building new ways to engage with members as well as patients as part of plans to boost its advocacy prowess, with a new government set to shake up the health system.

A paediatrician in Sydney, she spoke with the limbic shortly after being officially named to the role last month.

the limbic: Congratulations on your new role. What are you hoping to achieve?

Dr Jacqueline Small: I am really excited to become president of the RACP. It’s a really important role and it’s a really important college so I want to make the most of the opportunity.

I think I’m similar to previous presidents in that I stand for the excellence of our trainees and fellows. I have a genuine commitment to improving the health of our community. I’m also really interested in seeing health reforms so there is much greater equity.

However, my story is different to many of my predecessors in that I’ve worked part time and spent time raising my children alongside my paediatric practice as a developmental paediatrician. It is something that is more reflective of the experiences of many of my women colleagues, particularly now a lot of trainees.

I think it’s important to share the message that you can do that and still make contributions to our profession.

In terms of my priorities, I want to build new ways of engaging with members, who are very busy and are often part of other organisations like specialty societies or local professional groups. But I say the RACP has a lot to contribute across all 33 specialties in the college. We have a lot in common.

So in the last few years the board has gone out to meet with members where they work. We have introduced the RACP online community as a way for members to communicate with each other. It is proving to be very interesting, sometimes provocative, and it is also hopefully going to be a more targeted way for the college to communicate with members instead of email.

The other main area that I’m really excited about is policy and advocacy. We have recently developed a new approach in this area to enhance our effectiveness and I am really pleased that we’re going to be increasing the involvement of consumers and members of the community, recognising that their voice is crucial for being effective. That will also be crucial for finding the right problems and identifying the right solutions. We’re really going to be putting a lot more focus on looking at health system reform. It’s a high priority given the experience of COVID-19.

the limbic: You talked about wanting a bigger voice in Canberra. What are the main goals?

Dr Small: There is a range of things I’d like to see, recognising the diversity of our college. Some of the top agendas at the moment for us are supporting child health and particularly catch-up after covid. Climate change and health is another one, looking at what the health system can do to address climate change and be better prepared for its growing impacts.

We’ll also be seeking to actively engage in other aspects of health policy, particularly telehealth which remains very important for our members, as well as actively advocating for the needs of people with disability.

the limbic: What about the college exams? Are we likely to see any reforms to the exam system which has had so many problems?

Dr Small: There is quite extensive reform going on more broadly in the education of medical specialist trainees. Although computer-based testing has had the most visibility, there are quite a lot of other reforms that we are confident we’ll continue to align our trainees with international best practice.

We’re also committed to progressing our trainees through the last few years and that required quite a lot of adaptation to various parts of our exams. While that was extremely complex, we’re pleased that the trainees were by and large able to progress through the last few years.

Our commitment is to ensure that we continue to deliver exams while we have used paper for many years, that is the back up at the moment. We’re still trying to understand the issues that we experienced with the last exam and then really revisit where we want to go in the future.

the limbic: You were elected on a platform of reforming the college and solving the governance issues which have plagued it for years. Will that still be a major focus?

Dr Small: I think that what I have outlined is where I see the college going in the future. Building relationships allows all sorts of dialogues to occur and sometimes we need to hear some things that make us uncomfortable. That drives change.

An example would be the experiences of trainees and we need to continue to be able to share those.

But my focus and the focus of the board will be on the future and what the college needs going forward. And I have no doubt that there will continue to be significant change moving forward and that is appropriate for the evolving needs of our communities and the evolving expectations of our trainees and fellows.

the limbic: Are the wounds of the past few years healed? Is everyone ready to move on?

Dr Small: My experience is that the broader fellowship wants to see a focus on improving the health of our community, on educating our trainees and on making a difference in the healthcare system. There is a lot of interest in our the health system works for people including those who are disadvantaged. I think that’s where our focus goes and that’s where our members want to see our focus.

the limbic: As we heard at the RACP congress, specialty training continues to be very unfriendly to families and tough on mothers in particular. How are you working to address that?

Dr Small: So the college has some responsibilities but we also work with workplaces who employ our trainees. We are aware that we have some levers as far as guiding and requiring certain types of experiences for our trainees. But we also recognise we can use our role as leaders in the profession and work with other colleagues to bring about broader change.

There are a number of areas that we are looking including increased flexibility for training, which is something that trainees have raised with the college.

A lot of the stories we heard at congress do show just how challenging the experience can be for some trainees. It’s very different from a couple of generations ago. Trainees are older than they used to be, they’re more likely to have working partners, to have greater debt and also to be raising families while they are training. All these things have an impact so our policies and practices need to keep up so no one is disadvantaged.

the limbic: Women have made up more than half of all specialist trainees for some time, but a huge gender imbalance still exists in specialties like cardiology, where only about one-fifth of fellows are female. What can the college do to address that balance?

Dr Small: There are a number of strategies the college is using to better understand and respond to inequities that remain in our profession. The first is working with our partners, be they specialist societies or the surgical college or others to understand the power of data. By revealing this type of disparity helps us to understand to a greater depth more than just what an average number might tell us.

That shows us that 60% of our trainees are women currently, which is different to when I was training, but if you then break that down you can see there are still significant disparities.

We want to make sure there is appropriate engagement of all genders across all of the training schemes everyone is supported right through their professional lives.

the limbic: Is an even gender split across all specialties achievable?

Dr Small: Our college has not established gender targets. I know there is quite a lot debate about the role of targets but I think there are other ways that we can work as a profession and as a college to understand the gender inequities and to try to address that.

One way is just as you’re saying, to understand that in some areas there’s still significant shortages of women and to be very deliberate in supporting role models for women and leadership of women in those areas.

We are doing a lot of that now but there is much more we can do. What has been really striking to me is that our partnership with the specialist societies is really valued. Some of them are themselves part of international movements to improve gender equity in medicine. So there really is a movement and I think the time has come to address that in a deliberate way.

This conversation has been edited for clarity.

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