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I WAS dismayed when I got the email about the recent decision by the Royal Australian College of General Practitioners (RACGP), Australia’s largest medical college, to appoint former Victorian Police Commissioner Christine Nixon as the Chair of its Council.
Her appointment has already made Wikipedia:
“In October 2019 Nixon was selected as the chair of the [RACGP] board. This was the first time in the college’s 61-year history that a non-GP was chosen for the role. She had been on the RACGP council since 2017. RACGP president Harry Nespolon praised her prior large organisations skills and said of the appointment: ‘Ideally we would have a GP chairing the RACGP as a member-based organisation, but at the moment, Christine is the right person’.”
This appointment comes on the heels of the resignation of long-standing CEO of the RACGP, Dr Zena Burgess, only a few weeks earlier.
The appointment of Ms Nixon was extraordinary – and, in my opinion, unacceptable – for a number of reasons.
Ms Nixon was a senior police officer who has extended her career by becoming a professional board director; she sits, or has sat, on many important boards, many with public profile – including Foster’s Group, the Alannah and Madeline Foundation, Onside Victoria, Operation Newstart Victoria and the Phoenix Club. She has also been appointed as Deputy Chancellor of Monash University.
In spite of these notable achievements, she is not trained in medicine.
Personally, I know many doctors who are Fellows of the Australian Institute of Company Directors (AICD); therefore the RACGP cannot infer that there are not enough doctors with the appropriate executive experience. Nowadays, it is not uncommon to come across doctors with law degrees and significant business and governance experience.
Chair versus CEO and role of boards
In modern businesses and organisations, boards (sometimes called councils or similar words) have many important functions, including:
- appointing and overseeing a CEO and sometimes senior managers;
- managing risk;
- setting and monitoring strategy and policy;
- approving budgets and ensuring good financial management; and
- driving good performance for the benefit of members and shareholders.
For more details, the AICD spells out the role of boards very well.
It is not the role of a board to manage operational matters; that role falls to the CEO and the staff. Operational issues tend to be more generic. That’s why CEOs can often move between different industries. It is also the reason why organisations can successfully recruit CEOs from outside their sectors.
It is also true that boards sometimes include CEOs or their CEOs attend board meetings; this is essential for the board to remain properly informed about the organisation’s affairs.
Furthermore, boards can also benefit from a diversity of views and experience. This is why more boards are co-opting directors from outside their industries and setting diversity targets.
But the Chair of the Board and the board at large need to have a strong understanding of the organisation’s mission, function and operations. It is for this reason that Chairs need to have a deep understanding of the organisation or at least the industry or profession in question.
In the past, I have written about the RACGP’s changing role and the de-medicalisation of the medical profession (here, here and here).
And few would dispute that the RACGP retains the following important functions:
- training and examining GP registrars;
- setting and maintaining standards; and
- managing continuing professional education of GPs.
Acquiring the knowledge and experience about those three areas of expertise takes many years. It is hard to imagine how one can achieve this without having at least worked as a GP; many may argue being a Fellow of the college would be the most rudimentary prerequisite.
At a stretch, an experienced director of another medical college may have knowledge and skills that could work.
Medicine is a complex profession. General practice is the broadest of the specialties, with the biggest of the college memberships.
To think that someone without medical training and medical work experience can somehow not only understand the specialty but then go far beyond that to understand the College and then go far beyond that again to lead policy and strategy is simply something I cannot accept.
From a strategic point, this fails because:
- it devalues members and Fellows, stating that they are not good enough to be Chair;
- it sets a very unfortunate precedent that now cannot be deleted from history;
- the Council itself has no faith in its GP directors to do the job; and
- it is a sign of board weakness that a co-opted director has to be made Chair.
If such an appointment was made by a government, private corporation or university, there would be outrage.
The fact that it has been done by Australia’s largest medical college causes outrage and sadness.
Dr Aniello Iannuzzi is a GP, a Visiting Medical Officer at Coonabarabran District Hospital, and a Clinical Associate Professor at the University of Sydney and University of New England. He is Chair of the Australian Doctors Federation.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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The RACGP was inially formed from self-annointed people back in the day and they worked hand in glove with government bureaucrats of the time to establish a closed shop clique accessing a widening rebate difference from the non-VR subcitizens. I.e. they have never acted as a ‘union’ group representing all doctors that are not involved in other specialities. To have this.already superannuated highly political ex-Victorian public sector non-medical person shoe-horned into the Board Chairman post should tell every GP in this country exactly what contempt this organisations executive has for those current members who are unfortunate enough to be paying their salaries.
I totally agree with the above Comment : ” I am of the opinion that general practice would have been immeasurably better off if the RACGP had never existed. ”
There is ONE SOLUTION :
The RACGP, as it stands today, is a mere PUPPET in the hands of the Govt. of the day, as it is a Govt. DEPENDENT Body, unlike the totally Independent A.M.A.
The R.A.C.G.P. needs to completely Break-free from the Shackles of SLAVERY to the Govt. of the day.
If the cost of TOTAL INDEPENDENCE from the Govt. of the day, means an increase in its Annual Membership Fees to a level even higher than the A.M.A.’s Fees , I for one would gladly pay the increased Annual Membership Fees.
I would do so, because I would then know that my R.A.C.G.P. would be able to Champion the Cause of its GPs un-hindered .
This NEW & INDEPENDENT R.A.C.G.P. would then be able to show its Clout, just as the A.M.A. has done so –
The A.M.A. has always successfully fought for & protected the best interests of the Specialists that it represents.
DR. AHAD KHAN
I left the RACGP in 1988 after deciding even that whatever the problems besetting general practice then and whatever those in the future to come, the RACGP was not the solution. The RACGP has not been an effective advocate for general practice. It has successfully sought to control and tax the profession. For example compulsory and exorbitant RACGP membership and CME fees if not a member for AHPRA and vocational medicare registration. Compare the Medicare rebate for home/nursing home visits with that for tradesmen and their hourly fees – particularly out of hours. I am of the opinion that general practice would have been immeasurably better off if the RACGP had never existed. It’s existence contributes to the government’s control of the profession. Christine Nixon would almost certainly enjoy an inflation indexed Victorian government defined superannuation pension. I am sure that there are eminent GP’s capable of being appointed to the role.
It’s a good thing and long overdue – an organization as big as this needs a skills based board, not GP heavy board that are just looking to protect their own interests ?
Yes, well said, and I support you in what you say, Ahad, and bravo for not hiding behind anonymity, which prompts me to do the same. Because the college and the AMA stand wanting on this issue, and they need to hear it from us grass roots GPs out there just how let down we feel. In doing so, will out myself as being the author of posts 3 & 7 myself as well.
What does it matter ?
RACGP with GPs at the Helm, has, over the years, BETRAYED us Coal-faced GPs & made us the POOREST Remunerated of the Medical Profession .
RACGP with GPs at the Helm, has, over the years, slept in Bed with the Govt. of the day & has shamelessly allowed Non-MBBSs to take on GP Work.
with disgust at this Shameless PRETENDERS – pretending they are the Champions of General Practice.
DR. AHAD KHAN
Reverse bias-
In last 20 years – Good quality and respected GPs have built up the educational standards of the College to a very high level. But these GPs don’t necessarily make good administrators.
BUT- there are also many GPs who have these skills who wouldn’t ever consider themselves to stand for these positions- e.g. They would be screened on their GP ability and reputation- by the hierarchy at the RACGP – whereas unfortunately now we a Board Chair who is not screened on the same value system.
I would humbly suggest that the College has a proper look at the expertise in its ranks- it may find some very well informed and skilled people that could be used in these role- using a methodology that eliminates their selection biases.
Any organisation can rise or fall on the skill and strength of its leadership. Don’t be afraid of a non GP. Be very choosy about your appointment of board chairperson.
A good thing and long overdue – an organization as big as this needs a skills based board, not GP heavy board that are just looking to protect their own interests ?
Good points Neil, and essentially what I said above in a more wordy way. Maybe because I feel more strongly than ever about it, having to swallow the unpleasant truth that in selecting GP, I failed to take full advantage of my qualifications, which were achieved after a lot of hard work, long hours of study, anti-social hours, and sacrifice of family time, and it’s too late for me to change that.
What matters for the CEO is not really whether they are a GP or not but how good they are at their job.
The police have fought for better working conditions and pay for their members.
Perhaps we need someone to fight for that for us GPs !!!
Otherwise no one will want to be a GP unless they do it as a hobby
The role of the Chair of the Board is to manage the Board. One, and only one of several elements of this, is to run the meetings of the Board to achieve the best outcomes for the organisation. Some years ago I remember a presentation from a former journalist who was hired by major companies to chair their board meetings, in which he explained his strategies for making those meetings were productive. These strategies included working to ensure that every member of the board expressed her or his views on the matter under discussion, and that decisions were made in the interests of the whole organisation rather than of those any member or faction. I am willing to see whether Christine Nixon can help the Board of the RACGP in this way.
Another good reason reinforcing why I left the RACGP some years ago for the ACRRM
Fundamentally, I disagree because up to now the chair has always been a GP, and how well did that work..?
GP is now at a crossroads. Barely viable as a specialty. Woefully underfunded and under resourced. Ridden roughshod over by Govt policy makers whenever they feel like it. Treated like second class speciality with humiliating, frustrating, and time-consuming restrictions gathering momentum every month.
Now officially proven by statistics to be the lowest remunerated speciality..! I can confirm that, by how much more frugal my retirement is turning out to be – way worse than I ever envisaged. Everyone running the college, medical and non-medical, went to sleep at the wheel I’m afraid. So, the hope is, this new Chair, with her extensive board background, and where the share-holders, (ie US GPs), of the companies involved would have been far less accepting of the woeful state of their affairs, would hopefully mean she will spot immediately the glaring dissonance between the finacial state of the college, and that of the share-holders it is supposed to be representing and advocating for, and bloody well do something concrete about it..!
For a start, I doubt someone with her experience would have sat by while the 5 year CPI freeze was put in place. It could have – and should have – been fought much harder..! I could go on, but what’s the point, now retired, nothing they do will affect my state of affairs. But it saddens me to realise I unwittingly trashed any hope of real financial security by choosing General Practice, even though it is still arguably the most important, and emotionally gratifying medical job out there. Trouble is, warm fuzzies do not pay bills..!
Demedicalising continues insidiously.Suggest sacking the whole board.
This is but one of many board appointments of people who know very little about the business of the the organisation. These appointments, often in the name of diversity, are to the detriment of the company and its functioning.