No Justice For Those Who Have Suffered Bullying, Discrimination and Sexual Harassment with Increased Surgical College Subscription Payments.

As Fellows of the Royal Australasian College of Surgeons, we pay annual subscriptions.  There is not a whole lot of practical choice but for us to pay these subscriptions if one wishes to be a practicing surgeon in Australia.  It has just been announced that the subscriptions for 2016 are going up and by a lot.  

Whilst the Consumer Price Index is sitting around 1.5%, it has just been announced that it will be going up by 6% to cover the cost of implementing recommendations of the Expert Advisory Group (EAG). 

As a reminder, the EAG had documented the serious extent to which bullying, discrimination and sexual harassment (BDSH) has existed within the male Anglo-Saxon dominated surgical establishment. 

Text from the RACS email advising of the fee increase

This increase represents a gross injustice for those who have suffered from bullying, discrimination and sexual harassment during their formative years in building a career in surgery.  Having been subjected to such treatment, they now must pay more for having had the privilege to have had such an experience.  

Meanwhile, the main perpetrators of such behavior remain unpunished and will not as they should, bear the brunt of the additional costs for the RACS to make good on their past behavior.  

These are fees that I paid in 2015 for the privilege of being a Fellow.

But the reality is that implementing EAG Recommendations is going to be a costly exercise and it is money that cannot be covered from its financial reserves.  Apart from these costs, the RACS remains at significant risk of litigation and financial settlements in the event individuals find the courage to commence legal proceedings.  The RACS doesn’t really have a choice but to fund the implementation of EAG Recommendations through a significant increase in Fellowship subscriptions and to apply this across the board.  

The fact that the RACS is understandably unable to adjust for who should or should not pay a greater or smaller contribution to cover these costs does not change the fact that it lacks justice.  It will undoubtedly leave a bitter taste for many Fellows who will begrudgingly pay their subscriptions for 2016.

I do have one axe to grind over the manner by which this increase is being applied. Rather than a general revenue surcharge buried into our overall subscription, I strongly believe the increase above CPI should be listed as a separate line entry to send a clear message to all Fellows that they are paying for the indiscretions of past and present surgeons engaging in BDSH.  Without this, the reason for the 'bumped up' subscriptions will be quickly forgotten.  The issue of BDSH and it being addressed by the EAG represents a very significant watershed moment in the history of the RACS.  It should not be devalued by being buried into general business.  I appeal to the RACS to make it a separate line entry.  Call it an "EAG Levy" or "EAG contribution" or whatever.

It is just important to make it transparent. Make it visible.  Do not allow it to be forgotten.  

Maybe it is all just about trying to make a good impression – I’m sure you will agree that the RACS needs to do everything it can do to improve the impression it gives to the general public and its Fellows.  It will cost the RACS nothing to implement this. The cost of giving a negative impression......... 

Related blog pieces

Actions must speak louder than words - RACS and the EAG

Bullying culture in surgery

Cardiac surgeons were the worst perpetrators of bullying behaviour

RACS Elections and Candidate Review

Election results shows that there is appetite for change in the RACS

Congratulations to Fellows of the RACS Who Have Voted For Diversity on College Council

We have seen an amazing result for the 2015 Royal Australasian College of Surgeons Council elections. 

All six women candidates were elected out of a total of 8 vacancies and from a field of 38 candidates.

In an earlier blog piece, I expressed concerns about diversity of the RACS Council. These are a few tweets expressing my concerns.

With only 6 women out of 38 candidates for the 8 vacancies on council, I held grave fears that much needed female representation on the RACS Council would not improve. The numbers of candidates, only 10 of 38,  who made any mention of issues relevant to the EAG Report was woefully low. I am so glad to be proven wrong.

Rather than just hope that RACS Fellows would take the effort to consider voting, it was important to get the message out there as to why voting was especially important on this occasion.This meant, spreading the word on social media, directly speaking with colleagues and mass emails. I hope that my efforts made a contribution to the final outcome.  

I was however, touched to receive a direct message from the RACS on Twitter stating 

"thank you for your efforts in promoting the elections, and supporting the candidates, across social media, it was greatly appreciated"

The EAG Report has had the RACS in the spotlight. To have an election result with the all too common outcome where all successful candidates were male, would have been a damning indictment on the College after all that has been said about a culture that needs to be overhauled.  

The results indicated that there is real appetite for change and demonstrates that there is indeed every reason to be hopeful about the future of the RACS as it catches up with community expectations.  

Congratulations to all of the successful candidates and let's hope that they live up to their promise to help change the culture within the field of surgery.  Congratulations also to voting Fellows of the RACS for demonstrating that there is an appetite for change.

Deceptive Surgical Billing Practices

Last year, the Royal Australian College of Surgeons issued a Press Release on the matter of excessive surgical fees.  The then President states “Although government data shows that almost 90 per cent of medical services in the private sector last year had no associated costs to patients we are still seeing reports in the media of excessive and even extortionate fees”.

How does the Government and other health organization’s get hold of this data? 

Lets look at the typical billing situation. When a surgeon bills a patient for a surgical service in the private sector, the entire fee is provided on an invoice with a breakdown of costs as appropriate.  The privately insured patient will take the invoice to Medicare Australia and their Health Fund.  Medicare and the Health Fund will pay 75% and 25% of the Medicare Benefit Schedule (MBS) Fee respectively. Most surgeons charge above the MBS fee and the difference between their surgical fee and MBS fee is the out of pocket gap payment that is the responsibility of the patient.  Obviously, data on the amount of the gap payment can be recorded. 

As a result of the publicity directed to the excessive amounts of gap payments, some surgeons had every reason to believe that information being collected about their practices had the potential to come back and bite them in the future. 

I used to think that this data was reliable. 

It never crossed my mind that surgeons would think of rorting this data collection to hide the fact that they were charging exorbitant fees.

I was contacted by an old friend who asked to catch up with me for a coffee.  Let's call him Bart (not his real name). Bart is smart man, and smells bullshit from a mile off. He had a story that he wanted run by me for my opinion. 

His wife had undergone surgery for breast cancer and had been referred to a plastic surgeon for breast reconstruction.   The surgical fee was quite large at $15,000 but he was prepared to pay this as the surgeon had come especially recommended by the oncologist, whose opinion they trusted unconditionally.  To be clear, he specified that he had no complaint or concern about the amount of the surgical fee. 

Bart wanted to reconcile why he was being given two separate accounts.  He was given one account for the value of $5000 which was to be the paperwork to be taken to Medicare and the Health Fund.  A further receipt was given for $10,000 which was attributed to gap payment.  This receipt made no reference to being a surgical service for which a rebate from Medicare or a Health Fund could be obtained.  Bart indicated that this seemed to be a bizarre way of doing things and had his suspicions that this might be something to do with deceptive practice.  It is easy to see how most people would not give it further thought since they have been billed exactly what they had been quoted. 

He saw my lights go on as he relayed this story to me.  It was plain obvious to me that this plastic surgeon was trying to deceive the Federal Government as to exactly what he was really charging the patient.  He was attempting to distract from any future attention that might be directed to him as a surgeon who was charging in the higher echelons for his surgical services.  As far as the government would be concerned, he was only charging $5000 for his surgical services in spite of the real fee being $15,000.

This is not illegal but I call it out for being a deceptive and unethical practice.

(The amounts are not the actual dollar amounts that Bart and his wife were charged but rounded to nearest sums to help illustrate the billing practice and to protect his anonymity.)

Why I've Been Using Uber Instead of Taxis

Uber is under attack.  

That’s easy to understand.  Taxi operators feel that their livelihood is at risk and state governments are losing out on tax revenue that they gouge out of the industry. To me, the arguments about safety and so forth is just disingenuous drivel to justify the attack on Uber. 

I have used taxis a lot but I now only use them when I really must. If I am not in a hurry, I would rather wait another 5 minutes to get an Uber ride rather than hop into an immediately available taxi.   It is not because it is cheaper - in fact I would be happy to pay a similar price for the service.  I am glad that Uber is disrupting the taxi industry as it seems that this is the only way to pull it into a customer focused service.

Taxi Drivers Need to Know Where They Are Going - Using a GPS is Okay

I am fed up with taxi drivers having no idea of where important landmarks are. Admittedly, I have this problem more so in Melbourne than any other Australian city. In recent times, I had a taxi driver who did not know how to get to the Hilton South Wharf (let’s make that he had never heard of the hotel). This is the major conference hotel attached to the Convention Centre and has been open for many years.  I showed him the way from the airport. When we were almost there, I pointed to the top of the hotel where the Hilton sign was easily visible. I put my head down for a few moments to check some emails and the next moment, he had missed the turn off and there we were, heading down Flinders Street towards East Melbourne.  Also, within the last 12 months, I had a driver who did not know where the Royal Melbourne Hospital in Parkville was located. I do not mind if they use a GPS - at least Uber drivers do not pretend to know where everything is located and will proudly use the GPS. In the two examples given, the drivers seemed too proud to use their GPS.  I have different expectations for taxi and Uber drivers in that I do expect professional licensed drivers to know where they are going. 

Clean Vehicles and Drivers Would Help

About 25% of the taxis I get into are grotty old vehicles or the driver is shabbily dressed and in need of deodorant. Just because they now need to wear a uniform has not necessarily made them look like professional drivers.  Maybe if they even just tucked their shirt in and did not have breath that smelt like an ashtray, that would be a good start.  Often the space around driver and the front seat is full of rubbish. To date, the vehicles I have encountered with Uber have been on average, far better than the average state of vehicles I have encountered with taxis.

Ordering a Taxi is a Painful Process

One of the most frustrating aspects of catching a taxi is when you order one. When the operator abruptly insists that 'it will be the next available', the eye rolling on their part is palpable.  You are subject to the lottery system where the 'next available’ taxi is who ever taps the accept button first.  Often I get a taxi that is 15 minutes away rather than the taxi that is around the corner from my pick up site because that driver was quicker with hitting the accept button.  To me, the next available taxi is the one that is closest to me that is available to accept my fare. 

Arachiac System of Standard Driver Shifts Needs to Change

The lack of flexibility of taxi shifts is also an annoyance. It seems that all taxi drivers are finishing their shifts at the same time - I am asking myself why is it that it is always at the time that I really needed a taxi pronto. This rigid approach is not customer focused. Uber has no specific shifts - drivers are available when they are available- simple as that.

No Andrew Bolt or Alan Jones on the Radio PLEASE

The radio. This is not a big ticket item at all but becomes a complaint to supplement all the other dissatisfaction with the taxi industry. They seem to have this love of talk back radio. If taxi drivers were to be thinking about their customers, they would and should know that many people find talk back radio with the likes of Alan Jones or Andrew Bolt to be offensive.  Any music of any genre is much less likely to offend a proportion of the patronage than that of toxic shock jocks.  My word of advice is to just not to have talk back stations on the radio unless requested and you will offend nobody.

As a grass roots user of taxi services, this is my take on it. 

Others may have a different take but my concerns about taxis are largely ignored and that is exactly why I am one of many who have gravitated to supporting Uber.  

Do patients contribute to God complex in surgeons?

The recent EAG Report commissioned by the Royal Australasian College of Surgeons suggests that there is a toxic culture of bullying, harrassment and sexual discrimination in surgery.  There are probably multiple reasons why this toxic culture exists.  

One reason that seems to attract less attention is the attitude of self importance and self entitlement and being beyond reproach – or in other words a God complex that surgeons have acquired through their own experiences and being trained to think this way from their mentors. 

Hardly a working day goes by without a patient or their relative telling me how brilliant I was in helping them in their prostate cancer journey. I am always humbled and appreciative of these positive comments.  However, I am a very well trained surgeon who works hard and is obsessive compulsive in trying to do the best for my patients.  I’m just doing my job.  I’m well paid for what I do.  I have amazing job satisfaction.  Often I feel that I have the best job in the world.

But why such adulation for a person who is simply doing their job well?  What we do for our patients is very personal so obviously means a great deal to them.  Additionally there is a significant power imbalance, particular with knowledge and the fact that patients effectively surrender their trust upon us when we perform surgery upon them.

Patients are complicit to the God syndrome acquired by surgeons.  Health reporter Harriet Alexander is on the money when she  writes “For every surgeon who has a God complex, there is a bevy of complicit patients.”  If you keep telling surgeons how brilliant they are, after enough times, they’ll really start believing it.  By all means be appreciative of the work done by surgeons but time to stop the excessive praise for well trained individuals who are simply doing a great job of what they were trained to do.

The Royal Australasian College of Surgeons elections have commenced. Will it result in positive change?

The Royal Australasian College of Surgeons has been rocked by the scandal of there being a culture of bullying, harassment and sexual discrimination in the Expert Advisory Group’s Draft Report that was handed down just over a week ago.  We have seen a formal apology from the President of the RACS and a promise that there is going to be change.  RACS policy and culture is determined by RACS Council which is made up of elected Fellows. 

Without doubt, the EAG Report is the ‘biggest ticket’ item that requires the attention of the RACS Council. The final EAG Report and the recommendations that arise from it will again place the RACS in the public spotlight.  The RACS has been applauded for commissioning the independent EAG Report which had every expectation of producing findings that would be highly damaging to the reputation of the surgical profession. When the RACS announces how it intends on tackling bullying, discrimination and sexual harassment for the future could be a watershed moment in the credibility for the organization and profession.

Right now is an extremely important time for the RACS. Voting in the elections for members of the RACS Council opened on Friday 18 September and will close on Monday 5 October 2015.  How the Fellows of the RACS vote could impact on public confidence on how serious the organization is in tackling bullying, discrimination and sexual harassment.  

There are 38 candidates for the 8 positions that are up for grabs.  The EAG Report should be the biggest ticket item on the agenda, but only 10 candidates have made mention of issues surrounding the findings of this report.  That’s right, only 10 candidates thought the issue important enough to place in their electoral statements.  Of those 10 candidates, 5 are women.  It gets very interesting when we consider that there are only 6 candidates who are women. It is clear that women consider the findings of the EAG Report to be of considerable importance and arguably more so than their male counterparts.

Let’s also look at the ethnicity of the candidates.  Of the 38 candidates, 34 are Caucasian, 2 Chinese and 2 from the subcontinent.  Of further interest, surgeons who either currently hold senior positions within the RACS or have done so in the very recent past have nominated 22 of the 38 candidates.  These nominating surgeons carry very high profiles and are highly respected within the profession and their support of a candidate does carry weight.  If this were not the case, candidates would not seek to have their names listed next to theirs in their electoral statements.  Alternatively, rather than these candidates seeking to have such nominators, could it be a case of like minded candidates being the ones who get the tap on the shoulder?

The average age of the candidates is 56 years, ranging from 34 to 72 years. The majority of candidates are clustered between 50 to 60 years of age. There are only 5 candidates who are less than 50 years of age. There is only one candidate who is less than 40 years of age.  How dare this person run for RACS Council you might ask?

The youngest candidate is Dr Nikki Stamp who has everything working against her in having any chance of being elected.  Apart from being female, she is also by far the youngest candidate and does not have the nomination support of the high profile RACS 'heavyweights'.  She is however, passionate about equality in all aspects of healthcare and determined to see the RACS make a difference with the issue of bullying, harassment and sexual discrimination.  She has her own stories but right now there is a bigger missionat hand and in order to make a difference, she needs to be elected to the RACS Council. She will disrupt the RACS Council but for all the right reasons.

If you are Fellow of the RACS and feel serious about change, do vote for Dr Nikki Stamp.  If otherwise, tell surgeons that you do know, to not just consider her candidature, but to vote for her. 

The RACS needs to change but the demographics of those who seek positions on the RACS Council makes me nervous about what the future holds.



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For those interested, this previous piece "Action Must Speak Louder Than Words" which is  about the EAG Report may be of interest