RANZCO roundup: highlights from the 2024 congress

The RANZCO Plenary session at the college’s annual congress often acts as an excellent barometer for the health of ophthalmology in Australia.

The hour-long session is a moment for prominent RANZCO figures to update fellows on various workforce and eyecare accessibility issues across Australia, while also highlighting the college’s relevance in two spheres: the contemporary medical landscape and eyecare ecosystem.

But it’s on this final point that plenary chair Dr Grant Raymond, who ended his two-year RANZCO presidential term at the congress in Adelaide 1-4 November 2024, left fellows with plenty to ponder.

He said RANZCO and other specialist medical colleges had never been under greater government scrutiny. In the last 16 months alone, the college has made some 41 written responses.

“Some 14 important government reviews have been or are presently under way. This is a massive resourcing and financial impost on RANZCO. The price we are paying for having a seat at the table is very high,” said Dr Raymond who passed the presidential reins over to Professor Peter McCluskey with Dr Diana Conrad now vice president.

The two most pressing issues for RANZCO are the Kruk review and the National Health Practitioner Ombudsman Review – and Dr Raymond made RANZCO’s position very clear on these two matters.

On the Kruk review, which is fast-tracking specialist international medical graduates (SIMGs) into Australia, he said doctors from certain countries will be entering the national health system through expedited Ahpra pathways – without college assessment. They would only be supervised for six months.

With ophthalmology expected to be involved in 2025, he said there is no individual assessment of experience, breadth of practice or recency of practice.

“RANZCO believes this approach, with limited assessment and oversight will produce patient safety and quality of practice issues, it will likely exacerbate issues with workforce maldistribution and worsen rural training options.

“What is needed is investment in public hospital regional and rural health services and increased regional and rural training posts. The band aid the government is proposing is nothing more than a temporary part-solution.”

He said RANZCO would “demonstrate good faith” by developing its own expedited pathway that would only be for SIMGs assessed as substantially comparable.

RANZCO’s present figures suggest 47% of English SIMG applicants when assessed individually are not considered substantially comparable with Australian-trained ophthalmologists.

On the National Health Practitioner Ombudsman – “the new cop on the block” – Dr Raymond said it was uncertain whether the Australian Medical Council will take control away from colleges for accrediting training posts in public hospitals.

“Should SIMG assessment and hospital training post accreditation be taken away from colleges, RANZCO’s role will be substantively changed. RANZCO is somewhat a recipient of collateral damage from some problematic issues with other colleges,” he said.

“Watch this space.”

Tasmania ophthalmologist Dr Kristin Bell, the RANZCO Vision 2030 and beyond clinician lead, said a lot of these issues came down to poor governance over the years and a lack of accountability of state and federal governments.

It’s led to “huge gaps in service delivery” that’s “ad hoc” across Australia, disadvantaging regional and vulnerable Australians. Preventable blindness in these communities isn’t something that sat well with the college, she said.

“The consequences are coming home to roost for the governments of Australia, and hence this is probably the driver for the regulatory changes that [Dr Grant Raymond] has mentioned. Governments are getting a bit desperate. We’re running short on GPs, the workforce is in the wrong place and, not surprisingly, people are starting to notice.”

Fast-tracking overseas trained doctors into Australia was a knee jerk, band aid option that would not deliver a sustainable solution.

Instead, government should be investing in public hospitals.

“They grow our workforce, and they also determine where our workforce into the future is distributed,” she said.

Big inroads into First Nations workforce

Meanwhile, Dr John Kennedy’s update on RANZCO’s philanthropic activities through the Australia and New Zealand Eye Foundation (ANZEF) came with a more upbeat tone.

Most encouraging is the pipeline of First Nations ophthalmologists for Australia and New Zealand.

Currently, there’s just one Indigenous ophthalmologist in Australia, Dr Kris Rallah-Baker – a major underrepresentation with 3% of the population Aboriginal or Torres Strait Islander. And in New Zealand – where 18% of the population are Maori – there’s just four Maori and two Pasifika ophthalmologists.

“The simple premise is that despite massive efforts over the years, Indigenous eye health remains in a less-than-ideal state. If there were more Indigenous ophthalmologists, then they may take the lead in addressing the problems in their communities, and ANZEF is actively promoting projects to increase the number of trainees.

A big part of this has been reducing financial barriers for First Nations trainees such as $30,000 towards the $50,000-$60,000 exam and administration costs over the five-year training program.

After beginning the program in 2022, by next year there will be 10 First Nations trainees in the program – evenly split across Australia and New Zealand. “Our college leads the way among medical specialties,” Dr Kennedy noted.

“As well as supporting trainee eye registrars, we have a program to get Indigenous medical students switched on to a career in ophthalmology. There are currently two fourth-year medical students at UNSW completing an Indigenous Ophthalmology Award scholarship, and there’s a new Glaukos three-year grant for medical students in South Australia from Adelaide and Flinders universities.

“Currently, one way or another, we have more than 40 First Nations medical students and junior doctors engaged with ophthalmology as a potential career.”

Dr Kennedy also acknowledged the ANZEF-Alcon partnership worth $47,000 a year over three years for some 100 scholarships throughout Australia, New Zealand and the Pacific region.

Highlights from the conference and trade floor

The first full official day of the meeting started on an inspiring note with keynote speaker Tim Jarvis AM offering sage leadership advice he gleaned from retracing a miracle Antarctic expedition of Ernest Shackleton with the same equipment and clothing.

He expertly weaved in some key messages around climate change and sustainability – and gave the audience which totalled 2,222 over the four days – plenty to think about when it comes to medical waste.

“The carbon footprint of the medical industry in Australia is twice that of aviation, can you believe?”

He urged leaders to distinguish between their vision and mission.

“Shackleton didn’t use these words, but my take on it is that he said, ‘look, the mission is to cross Antarctica. Unfortunately, now it’s off with the loss of the ship. The new mission is to save ourselves. The good news is the vision is still very much intact.

“The vision was to do something at the limits of human endurance, return heroes or whatever it might have been. It’s very important to have a clear understanding of what the vision is. If all you’ve got is a mission, it makes it very difficult to change the way you do things.”

Among the major lectures, Professor Robyn Jamieson’s Ida Mann Lecture on the future of gene therapies and precision medicine was a highlight, as was Dr Rosa Braga-Mele’s cataract update that covered a tremendous amount of territory from exercises avoid musculoskeletal pain through to the latest phaco technology.

Flinders University’s Professor Justine Smith had a full house for her update on the “wide world of uveitis”. And Professor Stuart McGregor’s description of how an Australian team translated a polygenic risk score (saliva test) from the lab into commercial use through the company Seonix Bio offered a glimpse into how eyecare professionals may soon identify patients at risk of glaucoma and other diseases like keratoconus.

On the exhibition floor, the big talking points were Alcon’s new Unity Vitreoretinal Cataract System and UNITY Cataract System. They were contained in a closed off area with only selected surgeons able to experience the technology that will effectively replace its Constellation Vision System and Centurion Vision System with Active Sentry, respectively.

ZEISS and Bausch + Lomb Surgical also made their presence felt with their new surgical microscope technologies while Glaukos Corporation proudly showed off its new three-stent iStent infinite system for glaucoma.

And there was also plenty of interest in the new spiral intraocular lens (IOL) design from Rayner, Galaxy and Galaxy Toric.

Graduation and awards evening  

• 33 doctors admitted as fellows by the Vocational Training Program pathway
• 5 doctors admitted as fellows by the Specialist International Medical Graduate pathway
• Dr David Lubeck admitted as a fellows by the Ophthalmologist of Eminence pathway

Trainer of Excellence 2024

• Dr Alexandra Crawford – New Zealand
• Dr Anne Malatt – Sydney Eye Hospital
• Dr Ben LaHood – South Australia
• Dr Geoffrey Chan – Western Australia
• Dr John Downie – Prince of Wales Hospital Prof Shuan Dai – Queensland
• Dr Szczepan Nowakowski – Victoria
• Dr Colin Thompson – Regionally Enhanced Training Network

College Awards