TSANZ has accused the Asian Pacific Society of Respirology of applying unfair membership requirements to Australian and New Zealand clinicians while maintaining an ‘all-male leadership team’, in the latest war of words between the two groups.

The comments mark a significant escalation in the dispute between TSANZ and the APSR, which began when their Memorandum of Understanding lapsed in December 2023.

TSANZ has refused to sign a new MOU requiring automatic APSR membership for all its members, instead proposing an opt-in model similar to arrangements with the European Respiratory Society, American Thoracic Society and World Association for Bronchology and Interventional Pulmonology.

In an email sent to members on Tuesday, TSANZ President Natasha Smallwood accused APSR of applying its mandatory en bloc membership requirement inconsistently, claiming countries including Hong Kong, Vietnam, the Philippines and South Korea hold en bloc status despite not enrolling all members.

“TSANZ has also received written confirmation from APSR stating that the 100% membership requirement for en bloc status is not enforced,” she wrote.

“This means that, while other countries are not required to have full member sign-up to qualify as en bloc, TSANZ is held to that 100% standard.”

The society claims APSR has “repeatedly stated that all national respiratory societies follow the same compulsory en bloc model” but that TSANZ “has since confirmed this is not consistently applied.”

Under the proposed arrangement, TSANZ would be required to collect and remit US$60 (approximately A$91) annually for each member – representing about 16% of an Ordinary Member’s annual TSANZ fee or 31% of an Associate Member’s fee.

Only 145 individuals based in Australia or New Zealand have opted to join APSR in 2025, including those granted complimentary membership. It is not known how many are TSANZ members.

Professor Natasha Smallwood

By comparison, 672 TSANZ members belong to the ERS, 396 to the ATS and 156 to the WABIP.

Professor Smallwood also raised the issue of gender inclusion at the top of APSR, claiming that “all current APSR Officers (the Society’s highest office bearers) are male physicians.

She said of 27 APSR Fellows based in Australia and New Zealand, only four were women and five were non-physicians.

“Whilst there have been some improvements in representation of women in recent years, opportunities for non-physicians continue to be very limited and pathways for engagement are not clear,” she wrote.

Negotiations at impasse

TSANZ says it has held two formal meetings with APSR, sent six official letters and proposed two different revised MOUs based on an opt-in model since 2023.

“Unfortunately, APSR has rejected an opt-in model, maintaining that APSR mandates that all national respiratory societies adopt compulsory en bloc membership,” Professor Smallwood said.

Beyond that, “several additional meeting requests, including an offer to meet at the May 2025 ATS International Conference and the September 2025 ERS Conference, were declined.’

“We would like to maintain a positive relationship with APSR and TSANZ values engagement in the Asia Pacific region, but any future agreement with APSR must be transparent, equitable, and offer demonstrable value to our members while being in line with TSANZ’s Diversity and Inclusion Guideline.”

“TSANZ is a multiprofessional, inclusive Society, and our Diversity and Inclusion Guideline now underpins all partnerships and governance decisions. We are committed to ensuring that all members (regardless of discipline, gender, or career stage) are provided with meaningful opportunities for national and international engagement and leadership roles.”

Senior physicians push back

The dispute has divided the Australian respiratory community. In February, six prominent respiratory physicians including Professors Philip Bardin, Christine Jenkins and Christine McDonald warned in a Respirology editorial that TSANZ’s regional influence “is likely to be permanently damaged and may ultimately be squandered.” [read our article here].

The editorial authors compared en bloc membership with gym membership, arguing “members might not take advantage of all the gym has to offer, all the time, but it is there for members to utilise if they so choose.”

“We believe TSANZ has an important leadership role to play in the Asia-Pacific via our membership of APSR,” they wrote.

Professor Anne Holland, TSANZ president until March, told the limbic she was surprised by the public criticism, noting the authors had not approached the board directly with their concerns.

TSANZ is continuing negotiations with APSR while planning a member survey in the fourth quarter of 2025 to assess what members value in a potential APSR relationship.

The society has invited member feedback ahead of the planned survey.

APSR was contacted for comment but had not replied at the time of going to press.