Some are asking whether the RACGP's power has come with arrogance and a lack of empathy
A very strange thing happened between the medical press and the RACGP Last week
Both major news magazines, Australian Doctor and The Medical Republic, were separately invited to talk to RACGP President Dr Bastian Seidel about recent stories in both publications regarding PLAN, the new triennium education policies and claims of potentially anti-competitive behaviour.
But neither publication was told initially the RACGP planned hosting both groups in the same room with Dr Seidel, and, that it intended on filming the session and posting it on its website.
This is what we call in the trade a public relations “set-up”. Generally, journalistic organisations don’t go in for being PR bunnies. When we want to truly understand stuff, we just go and talk to key people, often, off the record.
When both groups learnt of the plan, we independently said we wouldn’t do it. The Medical Republic agreed to talk and to be recorded, but only with the College, so we could ask the hard questions.
We suggested to the RACGP communications manager that filming might inhibit the communication, but the College was adamant.
So although we felt the set-up was decidedly staged, we agreed because we wanted to hear what the RACGP had to say, staged or not.
Our session didn’t start very well. The RACGP’s chief executive, Zena Burgess, and the communications manager sat behind the camera. When asked whether she would be recorded with the rest of us, she said no, “I’m not here to answer questions”.
I pointed out that as commercial head of the organisation, it would be useful to have her input. No, she repeated, the CEO doesn’t answer questions. “It’s not convention”.
It was hard to understand what she was doing there.
OK, bad start. But Medical Republic journalist Julie Lambert and I went on camera with Dr Seidel, while the CEO and the communications manager watched from behind the camera.
This all started to make sense when things got a little hot. The communications manager reached for the pause button, saying he was stopping the tape. I refused, as it seemed the College was hosting an honest Q&A session until it didn’t suit them.
The communications manager had promised the video would be posted unedited. At an hour long, I’m guessing it might be fairly boring. But let’s see.
The following is a summary – my interpretation – of what Dr Seidel told us. But, of course, you can decide for yourself, if indeed the College does post it unedited.
• Nearly all the stories written about PLAN and the RACGP’s new triennium plans by the medical press are ill-informed and misleading. Hence the need for the College to hold this session and correct the record.
• Education providers actually have no problems with the changes, including the PLAN module, and their only issue is the new $2 upload fee, and that isn’t much of an issue either. There’s a lot of fuss being made over not much.
• The $2 upload fee is a necessary increase for education providers because of the increasing burden of administration for the RACGP in running education. Over the triennium, Dr Seidel estimated the new fee would raise $500,000.
• The RACGP is not in the least bit powerful in the education market. In fact, it doesn’t really compete in the education sector. All it does is meet the needs of its members as directed largely by the Australian Medical Board.
• All the changes have essentially been required by the Australian Medical Board and the College members and no one is actually unhappy.
• Essentially, everyone who has talked to Australian Doctor and The Medical Republic, including providers which are submitting ACCC complaints, has no reason to complain. They all just don’t understand.
• The RACGP is not market powerful, it consults widely, it requires more money than last year’s 15% increase in revenues to look after its members’ needs, and essentially the medical press should get their act together and realise the RACGP is doing the right thing in all respects. It always has, and probably always will. In other words, really no one should be questioning what it is doing.
The Medical Republic is at a rather large disadvantage in many respects in these events.
My reading is that many GPs are rightly proud of the College and rightly proud of being members. And while I’m not saying the College hierarchy are evildoers with hidden agendas – something which Dr Seidel said he felt we were saying in many of our articles – I am saying it is a very powerful organisation that doesn’t listen much. And at the very least, it lacks empathy.
One issue I struggle with is whether the RACGP realises how powerful it is. When I try to discuss this with the College, it always deflects and says it’s simply not so. It’s as if they believe having charity status and being a member organisation somehow exonerates it from the normal commercial definition of “market power”.
Let me be clear. There is nothing inherently wrong with being powerful – especially if you use that power in a constructive way. But you do have to be careful. And after our one-on-one with the College, it’s my view it is not being nearly careful enough about the power it wields and continues to deny.
Why do I say this?
• The RACGP more or less owns the GP qualification, with about 90% of GPs completing their training through the College. This makes sense, but there are problems with controlling 90% of governance and the training program.
• There isn’t a lot of choice if you think things are wrong and you’d like to do your training elsewhere.
• The College owns GP education. It governs education and provides 25% of the CPD modules in the market, making it the largest single provider by a very long way, making a lot of money along the way. Dr Seidel denied this in our meeting. So I will clarify. The College generates a lot of revenue from providing education to members.
• The control of education governance means the RACGP dictates terms for the 450 or so for-profit and non-profit providers of CPD-based medical education. If the College puts your fees up, say, by adding a $2 upload fee for the next triennium, if you don’t like it, you have nowhere to go. You suck it up, or you do something else. That is massive market power that you have to be very careful with.
• I estimate that the $2 fee may earn over a $1 million of revenue within the triennium, depending on a few variables. Remember, the RACGP is a charity organisation so does not pay much, or any, tax. It had revenues of more than $57 million last year, and that represented an increase in revenue over the previous year of nearly 15%, or $7 million. The College also had about $20 million in cash on its balance sheet. This is – and good on it – an organisation in very robust financial shape. The College says it needs more and more money to do more and more good. But who is really overseeing all of that power, growth and financial clout?
• With all the above power and more, the College is unmoving in its view that the changes thrust upon its competitors in the medical education market and its members with introduction of PLAN, and other triennium changes, are not in the least bit troublesome. No issues whatsoever, to be clear. The College seems to genuinely believe that all the fuss comes from a small bunch of whingers who don’t get the big picture and, of course, the crazy medical press.
I’m actually prepared to accept that the College might just be right. The complaints we’ve received aren’t in number large enough to send the college broke. Maybe the medical press is just reporting on the vocal minority, and the greater good is served by the College holding its ground and convincing its members the medical press is getting things woefully wrong. Was that not, after all, the purpose of this “staged” get-together?
But if it is right, it is still wrong. We’ve listened to providers and GPs who are genuinely distressed and upset. Some providers are reconsidering their livelihoods as a result of the changes. Dr Seidel dismissed these claims as fanciful.
The College can’t claim that it consulted widely on these changes with major stakeholders before it made its decisions, as required by the Australian Medical Board.
It didn’t. The changes landed like a bomb on providers. And we’ve encountered a lot of GPs who are thoroughly confused by PLAN and why they have to do it.
I’m also guessing few of them don’t know yet that the College believes peer review could eventually make up part of self reflection in future PLAN programs. Goodness knows what that is going to look like, and it might be the right idea. But you need to consult about it properly before you drop it on the profession.
I think the College is doing this because it can. It goes to show how powerful the College is. It doesn’t actually have to engage in these people’s distress. And it doesn’t have to engage meaningfully with the medical press – which it didn’t in this session.
Let me repeat. I don’t think the College is doing this because it’s made up of bad people. Dr Seidel is smart and very well meaning. But the College does have its detractors, and power does strange
things to people. I don’t think you can simply ignore everyone, even if you happen to be right.
The College does have the power to dictate to both doctors and education providers. That is a huge responsibility to be managed very carefully.
The College isn’t, as it attempted to argue to us last week, perfect. It would do well to stop and listen more, as difficult and complicated as that can be. Empathy is vital when you are this influential and powerful.
But as Dr Seidel has told me directly now, I could be wrong.
