Issue 20 / 1 June 2015

KEY medical associations, such as the Royal Australasian College of Physicians, are embracing a culture of “managerialism” at the expense of retaining their core values, according to the authors of an article published in the MJA. (1)

However, the college has staunchly rejected the authors’ criticisms of its reforms in a response also published by the MJA. (2)

The authors of the article, led by Professor Paul Komesaroff, professor of medicine at Monash University and director of the Centre for Ethics in Medicine and Society, wrote that the transition of the Royal Australasian College of Physicians (RACP) from a co-operative association to a commercial enterprise run by professional managers epitomised a trend towards managerialism in Australia.

“The widespread adoption of managerialist principles and practices in Australia has led not to great efficiency and effectiveness but to a loss of cultural depth and communal values”, they wrote.

Dr Simon Longstaff, executive director of the St James Ethics Centre, said while he did not endorse the authors’ conclusions about specific organisations, the central concern raised in the article was an important issue for the profession to discuss.

“If you don’t ask this kind of question, you can drift quite unconsciously to a point where you lose some of the things that are distinctive about the profession that you belong to”, Dr Longstaff told MJA InSight.

“When you start to manage everything as if it is a collection of resources for the sake of efficiency, do you also have some risk of losing that human dimension that ought to be preserved?”

The MJA authors cited RACP reforms such as the disbanding of some expert advisory groups, and replacing the traditional council with a board, as concerning. They said a low point was reached last year when the RACP initiated action in the Federal Court against a group of members who were calling for a vote on introducing a requirement for transparency and accountability.

Professor Komesaroff, who is a fellow of the RACP, told MJA InSight a new petition had been presented to the RACP calling for a vote on a motion to reintroduce the principles of democracy and transparency into the organisation’s constitution.

He said the petition had been signed by more than 400 members and an extraordinary general meeting was expected to be held in early July.

An RACP spokesperson described the MJA article as “selective on the facts” and “incomplete”.

MJA InSight did attempt to get a more detailed response from the RACP to some of the issues raised in article, but the college chose not to respond.

The MJA agreed to publish a detailed response from the RACP online, and in an insert to be included with the Journal.

Speaking to MJA InSight, Professor Komesaroff said it was essential that associations such as the RACP changed over time, but the direction in which organisations were increasingly moving was concerning.

“Our complaint is not about managerial practices as such, but a particularly pernicious form of managerialism that we think has taken hold and has become a favoured model for institutional change around the country”, he said.

Professor Komesaroff said he was “hopeful and optimistic” that this “precious institution” would be reformed.

“There is a lot of good faith amongst the membership and physicians remain committed to the organisation. However, it is my belief that an overwhelming majority of physicians recognise that there is a need for democratic change and a review of the direction in which the organisation has moved in the past 7‒8 years.”

1. MJA 2015; 202: 519-521
2. MJA 2015; Online 1 June

(Photo: skynesher / iStock)


Poll

Is professional management now an essential part of running professional medical associations?
  • No – they should be run by members (43%, 66 Votes)
  • Maybe – if members’ interests are protected (37%, 57 Votes)
  • Yes – medicine is now more complex (20%, 31 Votes)

Total Voters: 154

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11 thoughts on “College direction questioned

  1. Dr John CARMODY says:

    For 30-40 years our universiries have been corporatised (much the same has happened at the ABC) to the detriment of collegial and intellectual life there.   International  “rankings” — a crass, demeaning part of this commercialisation — are made using critera which apply to corporations which produce “services” and “products”; neither word properly designates education and scholarship.

    Students are not  — “clients” or “customers”; they are our junior colleagues in the great venture of education, reflection and intellectual improvement.  Recent reports of fabricatioon of enrollees’ qualifications and assignments together with accounts of bullying in medicine are part of this process.  The responses of senior doctors to the latter allegations often sound like those of politicians and coprorate menagers. 

    Professional and intellectual life has been debased in Australia.

    When important organisations (like the ABC) are run by people with no creative experience of the aspirations and work of those orgainsations (properly understood), when universities are run by senior managers with little or no experience of what undergraduate teaching involves, then the causes of this debasement become clear.  Likewise, when professional organisations — medical societies and colleges — surrender their operations to generic managers then they run comparable risks.

    Of course, operations of big organisations (as they have all become) require managerial skills and financial prudence but not at the cost of their quiddity and their integrity

     

     

     

     

    doc

  2. University of Sydney says:

    At last someone who dares call a spade a spade. I’m afraid it’s not just RACP but most voluntary associations in Australia. My own college, RANZCOG, is slowly throttling us and our trainees with bureaucracy, driven by a managerial caste that is doing much more harm than good. And we’re made to pay for the privilege, adding insult to injury.

     

    HP Dietz

    Sydney

  3. Chris Strakosch says:

    The RACP of past times was not so great. Run by staff physicians from the large Sydney and Melbourne teaching hospitals with too much time on their hands. The persons sent to the more peripheral hospitals for the clinical exam of the FRACP(1) treated the exercise as if they were Imperial Inspectors reviewing one of the more remote and undesirable colonies. They were rude to the patients who had volunteered for the exam and treated their fellow physicians appointed to these hospitals with breathtaking arrogance. But they ran the only game in town so had to be tolerated. There is no doubt the present administrators (also a personal communication from a senior member of their staff) are probably no worse than their predecessors. Dedicated physicians are too busy caring for patients to devote time so we have to accept what we can get.

  4. Peter Graham Row says:

    I am afraid that Professor Komesaroff and his colleagues have missed the boat.  The learned Colleges have been fghting a losing battle against the intrusion of outside parties for decades.  The College of Physicians now must subject itself to “accreditation” by organised academia in the name of the AMC together with government-controlled registation boards ostensibly to “maintain standards” as required by politicians.  The RACP has thus been forced to secede the fundamental principle upon which the learned colleges were founded.  Unfortunatelly, all that is then left is an administrative shell and professionalism is now little more than a “quality indicator”.

  5. Brian Parker Gold Coast says:

    I agree with the above comments but would like to add that my College of Surgeons in Melbourne seems to have lost politeness in dealing with, say, an email , from a Fellow. It seems that no one in College Headquarters has the time to acknowledge the receipt of an email . I turned 80 recently and receved an 80th birthday card from the Royal College of Surgeons of Edinburgh. The Australian College did not appear to know my age at all !!!!

  6. Michael Kennedy says:

    Why does the response by “The Royal Australasian College of Physicians: a 21st century college” (to the refereed article by Komesaroff et al) have no author? Is this best practice managerialism of the new millenium?

  7. CIAP - NSW Health says:

    John Carmody must be watching a different ABC to the one most of us watch…

    Or maybe corporatisation is new-speak for a completed takeover by the political Left, with their relentless pushing of the usual “progressive” agendas. Using this new definition, the College certainly has been corporatised, as anyone reading the RACP News in the last 3-5 years would know.

    The College I joined 2 decades ago was committed to elevated educational, and even professional, goals. It has now become little more than yet another mouth-piece for activists who are best suited to organozations like Get Up! and New Matilda.

    If the planned referendum can do anything to reverse this collectivist, anti-democratic trend, it should be welcome by any thinking Physicians, but, just like ex-doctor above, I won’t hold my breath.

  8. Lynette Dioring says:

    The loss of courtesy and reasoned debate mystifies. I cannot speak of past decades, but democracy-returned could become a premis for new debates..

  9. Rohan Wilmott says:

    Managerialism is not only effecting the colleges, but is metastasising into all levels of society, especially Western society, to the general detriment of humanity.

    As a health “caring” profession, we have a duty to resist its evils as much as possible.

    I attribute the rising rates of depression, suicide, low satisfaction rates in employment, societal violence, general lack of compassion and philanthropy and the inability to solve problems in society in part to the “suck out the blood & throw away the skins” attitude engendered by managerialism.

    Managerialism is usually associated with a self-righteous smugness that believes that the managerial way is the only way and any human variation is to be extorpated.

    “All Hail” the core values of humanity and our professional duty of care. Management should be returned to the “helper” role, not the dominant “CNS function”, not only in our professional colleges, universities & corporations, but generally in society if there is to be a positive future for humanity. 

  10. Matthias Maiwald says:

    While I do not want to take a stand in this debate directly (I am not an RACP Fellow), I can nevertheless offer a partial (note, partial) reality check to anyone who is unsure whether they should lean towards Komesaroff et al’s opinion or that of the College.

    Go to: http://www.weaselwords.com.au

    The site is run by Don Watson, former speechwriter of PM Paul Keating. Watson takes aim at weaselwords and management-speak. The lingo portrayed is characterised by (a) unnecessarily pompous wording, with the aim of making the speaker/writer look/sound important, (b) being vague and imprecise, with a very low tangible information content per written/spoken sentence, and (c) making use of catchwords or phrases that are fashionable at a given time and – again – convey little factual information. Long-time favourite catchwords are, e.g., “strategic”, “stakeholder”, “governance” and the like.

    What I found is that use of this lingo is strongly associated with managerialism, although we need to keep in mind that this is only a small piece of a bigger puzzle of what constitutes managerialism. I also found that the use of this lingo is increasing in the medical field.

    The reality check is this: check the College’s written/spoken communication. If (a) it resembles what is on the website, then this may be a small piece of a bigger puzzle that may get you to lean towards Komesaroff’s opinion. If, however, (b) the College’s communication is always clear, precise and informative, then this may get you to lean towards the opinion in the rebuttal.

     I have not done this reality check myself, so I am genuinely unsure of the outcome.
     

  11. N170450@amamember says:

    One of the apsects of the New Managerialism is extreme risk aversion, using the tools of standardisation. As others have said, this is occurring in big organisations in all areas of life. This style is crippling hospitals and universities. It is not desgined to protect, or provide a better service for, the customer, but to protect the provider from criticism or challenge. In an attempt by the AMC to get the COlleges to improve their transparency and standardisation, there is a risk of such bureaucracy and dumbing down that any gains are exceeded by the downside – loss of subtlety in the assessment process, in trainee selection, in decision-making.

    It doesn’t have to be this way – we can improve tranparency and fairness without losing subtlety and rationality – but it takes strong leadership to do so.

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