6 June 2020

RACGP, ACRRM and AMA all facing survival inflection points

ACRRM AMA General practice RACGP

Major changes afoot at the RACGP plus an impending spill to the CPD monopoly of  the RACGP and ACRRM will soon challenge the viability of every major medical college who rely on GP engagement and support.

The RACGP might have been on the nose with members for many years now, likely in large part because of its failure to advocate effectively in Canberra to prevent many years of an MBS freeze, but it still is the largest medical college in the country by a long stretch, and in that there is much latent political potential.

But the political landscape and membership dynamics of all colleges are about to change significantly.

Last week we touched on the rapidly improving NPS score of the RACGP under current president Dr Harry Nespolon, a huge change from a somewhat downtrodden score of -50 two years ago, to a work-in-progress score of -17. The change indicates that  although likely still not on the Christmas card list of a lot of members, the RACGP, sans its long term CEO, might be on the march in terms of meaningful member engagement.

This week we can reveal new data from the HealthEd Pulse Survey series which compares the engagement of GPs across all the major Colleges of which GPs are members.

Although the headline results seem obvious there are some surprises in the detail.

For instance, ‘distant’ third may not be anywhere near enough to describe the relationship GPs have with the AMA when you consider that the overall NPS score among GPs for the AMA is -56, compared to -23 for their personal bank and +22 for their defence organisation.

In other words, GPs are struggling seriously to see any value in the AMA anymore.

In this same data series the RACGP has an improving NPS score to last week’s -17 score of ,now, -1. The improvement in just one week is explainable in part by the survey sample doubling and in part because of the context in which this week’s survey was conducted. No matter, the RACGP is seriously on the improve in the eyes of GPs and the AMA is so far back in the field you would struggle to understand why there are still 6000 GPs left as members.

These outlying AMA GP members will likely be seriously thinking about that membership return in the coming two years, especially if the next AMA president turns back to being a specialist, and any GP focus that the organisation had, will likely slip a few notches for obvious reasons.

What about ACRRM in this set up?

The NPS results are slightly more difficult to decipher because with a much smaller membership geo located mostly to rural areas, applying a general GP NPS score doesn’t work. It is in fact -53 but that is huge bias from the fact that 90% of GPs in the survey are RACGP members. If you filter to smaller towns and cities the ACRRM results moves rapidly upwards to -32 and if you filter for ACRRM members only it is as high as 22. But if you filter that way for the RACGP it moves up to 11. The long and the short of these numbers is the RACGP is probably just below the ACRRM numbers but vastly improving fast. Remember, ACRRM membership, is traditionally recognised for being massively loyal and rusted on.

RACGP member engagement was woeful a year ago (-50), but is vastly improving. They aren’t quite up to the score of ACRRM but for the first time in many years they are close, and it feels like, with the right management moving forward at the RACGP, it may move past ACRRM in the near future. Remember the RACGP has its own rural division that does a pretty good job.

The ramifications for all of these movements are pretty big in the near term if you’re a thrift GP thinking where you’re going to get biggest bang for your buck moving forward in a member organisation.

There are several major swing factors in play moving forward though:

  • Will the RACGP keep up its  momentum in advocacy, displayed fairly clearly during COVID-19 in convincing the government to drop their aversion to tele-health? This momentum has been great but still hasn’t been  powerful enough to force meaningful income change.
  • How will new legislation removing the monopoly of both the RACGP and ACRRM over CPD affect the membership and revenues of the two major GP colleges  moving forward and their ability to meet member needs, particularly in terms of advocacy?
  • Can the RACGP maintain the moment commenced under the current president with the appointment of a both a new CEO, and a new president elect sometime in the July/August timeframe?

Word is that the process for appointing a new RACGP CEO is being managed in a  manner that would put the RACGP on a much more robust path to becoming the lobbying and advocacy powerhouse that it always should have been with its huge revenue base and growth in membership.

The appointment of a new president is a little less synergistic to the same goals . There won’t  be much overlap with the current president because the election is running late and  the nature of RACGP presidential position means that there is often significant differences in outlook, management capability, and issues focus between presidents.

The RACGP is yet to formalise the nomination process for the upcoming election so we aren’t even able to question the current stable of candidates who have put their hand up, but if you look at the mix of candidates already, there are vast differences in their backgrounds and likely what focus they want to bring to the college. If you talk to the current president Dr Harry Nespolon he is adamant that the skillset that is most required in a College president is political savvy and advocacy. That is not a skillset that any GP naturally comes by in the course of their working lives, which means that most new presidents face an uphill battle in going to Canberra and being immediately impactful. There is a huge learning curve and with only two years in the job, not much time to get on top of that curve. It’s a systemic weakness in the RACGP set up and one which puts the new CEO position into the spotlight even more.

More than ever the new CEO is going to need to be a master politician as well as administrator.

A big irony for the RACGP and its members is that just when it has the money, membership and possibly a CEO to swing for the fence on GP remuneration and conditions with the Federal government,  the government is removing its monopoly on CPD and threatening both its membership numbers and revenue base moving forward.

If the new CPD regime, which allows other groups to set up in competition to the RACGP and ACRRM in providing a ‘home’ for parking all their CPD admin, governance and government accreditation for Medicare, starts to bite with GPs who have been members for the CPD service only, then they may rapidly lose members, revenue and ultimately their power to advocate in Canberra. If that does happen there will be much regret and wringing of hands about how the College executive likely squandered the last 10 years.

But that hasn’t happened yet.

The RACGP with a new CEO and the right president, can justifiably pitch to members that the return on their membership investment now more than ever stands a chance of actually shifting working conditions for GPs upwards meaningfully. It can do this with a refreshed and well tasked executive, and a new president,  starting way ahead of where it was two years ago, after a serious tilt at the job by the current president. It likely will also need to sharpen its pencil on CPD and membership fees to remain competitive, but this will be the easy part.

If the RACGP can retain most of its membership and apply its revenues in the manner it should have been for past 10 years in lobbying and advocacy, there is a better chance of a brighter future for GPs than there has been for over a decade now.

Where does that leave ACRRM?

With the right leadership in the RACGP the logical path for ACRRM is to finally come back into the fold. That would make the RACGP moving forward that much more powerful in what it is about to attempt.

That is not going to happen of course. Not at least in the short term. Many of the wounds between the two groups are still open and those that are closed have left large scars.

But it is logical in the mid to long term if general practice as a profession is to move forward.

And the AMA?

The AMA was once ‘the’ doctors union as far as government was concerned. ‘The’ lobbying group. That is now probably the first and foremost focus of the RACGP as far as GPS are concerned, and with far more members and money, the RACGP has now entirely usurped the AMA in this respect. It’s very hard to see what the future of the AMA is where GPs are concerned. In some respect that might even be said for specialists because the reality is that every specialist college now has their own lobbying focus in Canberra and use their own people for their colleges individual needs.

The only hiccup we might see in this picture is the AMA making a play for GPs via a new CPD offering, once the new legislation hits. But this seems unlikely given that both the RACGP and ACRRM have very extensive resources devoted to CPD and now the RACGP is moving into managing the entire GP training process.

The most important current change for GPs is a potential rebirthing of the RACGP under a new CEO with the professional where-with-all to take the momentum of the last two years, work effectively with the incoming president, drive change in Canberra, continue the good work on CPD and governance the College has always largely offered, and not stuff up the complex work of taking on all of GP training management.

It might be the best time ever for GPs to relook at how they currently engage with the RACGP and how they might in the future.


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