Women stopped from getting to the top

Women are struggling to make it into the upper echelons of the medical profession despite comprising an increasing majority of those embarking on a medical career.

Australian Institute of Health and Welfare figures show that last year women made up 40 per cent of the medical workforce and 53 per cent of early-career practitioners, including just over half of all specialists in training.

But, despite this, researchers have found that they are failing to progress through to senior positions in representative numbers, comprising less than a third of specialist college board members and medical school deans, 33 per cent of state Chief Medical Officers and just 12.5 per cent of large hospital CEOs.

A study of medical leadership in Australia, published in BMJ Open, has found that women are under-represented in medical leadership roles due to a combination of ill-informed attitudes and inflexible work and career demands.

Through detailed interviews with a sample of 30 medical leaders (22 of whom were men), a team of researchers from Melbourne University, Monash Health and Deakin University found although some thought the representation of women at senior levels would increase because of the pipeline of females entering the profession, the majority – both men and women – identified a series of barriers that prevented women from advancing.

“Most interviewees believed that gender-related barriers were impeding women’s ability to achieve and thrive in medical leadership roles,” the researchers said, and identified three broad impediments – perceptions of capacity, organisational arrangements and professional culture.

The most commonly-cited barrier was parenthood, with several medical leaders referring to an inherent incompatibility between high-level leadership and motherhood.

But several remarked on the tendency of managers, and women themselves, to underestimate their capabilities.

A number of leaders interviewed for the study, Reasons and remedies for under-representation of women in medical leadership roles, reported that women were often “not taken really seriously”, and were consider to be “too feminine” to be an effective leader.

In their findings, the researchers said that, as in other professions, the lack of women in senior leadership positions was justified by a range of explanations including it was “too soon” to see women in these roles, they were too busy with their families, or were not natural leaders.

The researchers said the basis for these explanations was thin, pointing out that women have made up a sizeable proportion of the medical workforce for decades and are still not moving into leadership roles in numbers consistent with their representation in the workforce.

On the career-limiting impact of parenting, they said that “cultural assumptions that childrearing and household responsibilities impede women from entering leadership roles is, at least in part, based on discriminatory social norms”.

They pointed out that inflexible work arrangements made this a structural, rather than inherently biological, barrier. Some of those interviewed for the study suggested that, rather than following a standard linear path, medical careers could be structured to follow a more M-shaped trajectory that would support women to enter, or re-enter, leadership roles at an older age “if that suited their life-course”.

The researchers cited cultural norms and unconscious biases in the medical profession about what a leader should look like, and how they should behave, as another impediment faced by women.

They also identified other institutional impediments. For example, because the responsibilities for childrearing and maintain a household continue to fall disproportionately on women, they tend to gravitate towards specialties that give them the time and flexibility to fulfil these roles, such as general practice and public health medicine.

But these specialties, the report said, tended to have a less influential presence in large health services compared with traditional male-dominated specialities, such as surgery.

“Achieving meaningful change will require us to move beyond ‘fixing the women’ to a systemic, institutional approach that acknowledges and addresses the impact of unconscious, gender-linked biases,” the researchers said. “Revisiting rigid career structures, providing flexible working hours, offering peer support, and ensuring appropriate development opportunities, may all assist women to enter leadership roles.”

Adrian Rollins

The drive to care, regardless

A hysterical woman is dumped at perimeter of an Australian Defence Force camp. Her abdomen has been crudely sliced open and then stitched up. Wary soldiers suspect she has been implanted with a live bomb.

A team of volunteer Australian Army Medical Corps doctors, accompanied by a bomb disposal expert, carefully operate on the woman, successfully extracting a land mine that had been inserted behind her rib cage and designed to go off as it was being pulled out.

It is a harrowing but true scene from Mohamed Khadra’s latest book, Honour, Duty, Courage, in which he seeks to answer why doctors and nurses with well-paid jobs and comfortable lives in Australia put it all on hold to go to poor and violent places to help complete strangers.

So who are these men and women, and why do they do it?

After picking at the puzzle for years Professor Khadra, a urological surgeon as well as an author, thinks he has a pretty fair idea.

“These are people driven to put their own needs and wants last,” Professor Khadra, who is head of surgery at Sydney Medical School, says. “They have an innate sense for protecting and nurturing others, and for fairness.”

For the book, Professor Khadra talked extensively to many men and women who have volunteered to serve the Australian Army Medical Corps in deployments that have plunged them into the heart of brutal armed conflicts.

What he found were people with an overriding sense of duty that drove them to serve, both at home and abroad.

“These are the people who are on multiple committees for the hospital, the college and the department. They are the ones who at high school organised charity days,” he says.

Professor Khadra himself shares many of these characteristics – in addition to his clinical work he serves on medical boards and committees, is a senior examiner, a head of department and is an active researcher.

But he says he is “completely humbled” by the selflessness and humanity of those who have served, and continue to volunteer for, army deployments.

“Some people ask what medicine can do for them. These people feel a duty to give back to medicine.”

But Professor Khadra’s account shows that they pay a high personal price for their devotion.

The relentless mental and physical demands of working in a forward medical post, faced daily with the threat of death and evidence of unspeakable depravity, mean anyone who serves in these roles does not leave unchanged.

“I don’t think you can see the atrocities to the depth that they have seen and not come back altered,” he says, though in recent years there has been improvements in support for those returning from service.

Not only do they bear emotional scars, but there is often a financial cost.

Professor Khadra says the payments the volunteers receive can be enough to keep the doors of their private practice open and pay their staff, but little more.

He says that most have only modest financial resources, and when they return after three months’ absence they often have to re-build their practice from scratch because patients have moved on to other practitioners.

To add indignity to the situation, often they face resentment from colleagues who have had to carry a bigger workload during their absence or, in at least one case Professor Khadra knows of, be accused of using their military service to try and drum up business from GPs.

Balanced against these disincentives is the powerful pull of duty.

But will that continue to be enough to ensure the Medical Corps will continue to play the role it has?

Professor Khadra is not sure.

He says there is a perception that those who have entered medicine in the last decade do not have the same sense of duty to give back as those who have come before them – a view fuelled by the difficulty encountered in finding younger colleagues willing to take on teaching duties.

But Professor Khadra is hopeful that, when the time comes, people will continue to step up as have the generations before them.

Adrian Rollins

Summer reads

Australian Medicine suggests a selection of books to stimulate and entertain this summer.

Honour, Duty, Courage. By Mohamed Khadra. Penguin Random House; 249 pages; $34.99

What drives doctors with good jobs and loving families to risk life and limb by volunteering to work in some of the most hazardous places in the world? In his latest book, Sydney-based surgeon Mohamed Khadra sets out to answer that question, interviewing dozens of health professionals about their experiences working as volunteers for the Australian Army Medical Corps. He creates two fictionalised characters to recount their stories, and what emerges is a portrait of people imbued with a strong sense of duty (and a penchant for adventure) who are severely tested, physically, mentally and emotionally. Deployed to a forward surgical unit in a war-torn country that could be Rwanda, Afghanistan or Iraq, the book’s two protagonists – emergency surgeon Dr Jack Foster and anaesthetist Dr Thomas McNeal – are confronted with extremes of human depravity and deep ethical dilemma as they cope with a relentless flow of casualties from all sides of the conflict. Khadra gives a sympathetic account of the often harrowing situations such volunteers confront, and how these experiences stay with them long after the deployment ends.

The Gluten Lie: And other myths about what you eat. By Alan Levinovitz. Black Inc; 272 pages; $22.99

For his day job, Alan Levinovitz researches religious myths to find out what they mean and why they are persuasive. With this background and expertise, it is no wonder he has turned his attention to the world of food. Few areas are as prone to fads, half-digested ideas and quackery than what we eat. Flick through any newspaper or magazine, or surf the web, and you will be quickly hit with advice about the latest ‘super-food’, fad diet or poisons lurking in what you eat. In his brightly written and tightly-argued book, Levinovitz seeks to chart how some of the big myths about food of our times have emerged and taken hold, causing many into dietary contortions as they seek to confine themselves to ‘safe’ foods. He examines the science and shows how mass beliefs, in some cases verging on hysteria, about MSG, salt, sugar, grains, meat and gluten have arisen, mostly based on very thin evidence. Unlike diet books, Levinovitz doesn’t dispense advice about what you should eat, but instead asks some hard questions of those who do.

Happiness by design: change what you do, not how you think. By Paul Dolan. Penguin Random House; 235 pages; $16.

For many years, the overriding advice for those seeking to improve their happiness has been to change their mindset. Bookshelves abound with tomes advising people to think their way to a good mood. But Paul Dolan takes a refreshingly different approach. Drawing on the latest research in behavioural economics and brain science, he draws some general conclusions. Climate, for instance, does not exert a major influence on satisfaction. Wherever people live, they acclimate to the weather and get on with other aspects of their lives. He repeats the well-founded observation that volunteering tends to be correlated with a great sense of purpose, while television is associated with a sense of pleasure. So, how do individuals improve their happiness. Following the dictum that attention shapes experience, Dolan advocates identifying the things in life from which you derive joy or contentment, and seeking to make room for more of these experiences. Hardly earth-shattering advice, but powerful in its own way. As a Scientific American reviewer observes, Dolan touches on an important idea: happiness need not be pursued, simply rediscovered. In other words, sources of pleasure and purpose are all around us, if only one knows where to look.

[Articles] Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

Does Christmas and moderation mix?

The big man will be stumbling from house to house as he consumes endless beers left outside Australian houses on Christmas night. There is not much call for milk and cookies anymore.

It used to be simple – a XXXX, a Tooheys or a Carlton Draught would do it.

Now there is a plethora of hipster micro-brewed beers to choose from for Santa’s repast. Perhaps a cool, aromatic, Belgian hopped mid-strength beer served in a broad-based balloon glass with a slice of lime. And, of course, with a macrobiotic quinoa juju berry cookie?

I love variety and the fact the range of choices has evolved.

But sometimes you just zip in for a can of Bundy and coke and end up spending 10 minutes passing your eyes over the mid-strength, zero sugar, O.P. or lime-infused options.

I must fully applaud the lower alcohol versions that now share shelf space with their heavier cousins.

Lower alcohol wines can be produced a number of ways – purposely picked early so there is less sugar to ferment, which means less alcohol. Another method is to stop the fermentation process by chilling the wine down, deactivating the yeast. Alcohol can be also reduced through reverse osmosis. Brewed beverages reduce alcohol by using less sugar in fermentation.

My substance abuse colleagues often wonder whether I should book in for a rehab spell, as I tell them I only drink wine for the taste.

Being inebriated is a real pain at Christmas. Putting the kids’ swing set together with 10 screws left over, you end with something resembling a work of Gaudi architecture. Always let the cousins go first.

Then there’s the slicing of the ham. Don’t let on there is a bit of fingertip somewhere in the mix.

Xmas used to be predictable for me. Smoked salmon and scrambled eggs with Veuve Cliquot Rose for breakfast. A bone dry aromatic Clare Riesling with oysters. A sparkling Red, usually Seppelts Show Reserve, with the ham and assorted meats. Maybe some Bass Phillip Pinot Noir with duck. A few German beers and a lie down.

Now we are more aware of our promoting responsible drinking, I am enthusiastically flying the flag for the low alcohol options.

Recently, I convinced the wife to do a mock Christmas lunch run, all in the name of research.

The oysters were paired with the 2014 Matua Lighter 9 per cent alcohol Marlborough Sauvignon Blanc. Very light color, with classic, yet subdued, gooseberry and lychee notes. The flavor is crisp with some diminished fruit and mouth feel.

Next we had an old fashioned prawn cocktail with the Lindeman’s early picked 8.5 per cent alcohol Semillon Sauvignon Blanc. Some attractive citrus grassy notes and white peach aromas were apparent. The nature of the wine is a rounded, medium fruit-driven wine with a crisp finish. Overall, it did its job.

The next challenge was roast duck with a mandarin and star anise-infused glaze. The Lindeman’s early picked Shiraz 8.5 per cent alcohol, with its reserved style, complemented it well. Restrained red currant aromas with mild vanillin oak influences were noticeable. Served slightly chilled, it had enough flavor to pair the meal.

Whilst not a classic plum pudding, my wife conjured up some form of sticky date pudding with brandy custard. Out of left field, I grabbed a Matso’s 3.5 per cent alcohol ginger beer from Broome. Spicy ginger notes and a nice balance of sweetness and herbal notes really matched well.

Using the practice Breathalyzer, I found I was under 0.05 and the other guests didn’t have to put up with suggestions that we turn on the Karaoke machine. Also, I could have easily erected the kids’ cubby house without it looking like the Ettamogah Pub.

Low alcohol beverages can run the risk of appearing to lack flavor – alcohol adds sweetness as well as providing a more complete tasting experience.

But overall, our low-alcohol mock Christmas lunch was a success.

Now to bring on the real thing!

News briefs

Loneliness can be a killer

A new study from the United States’ National Institutes of Health shows that loneliness can increase the risk of premature death in older adults by as much as 14%, Forbes reports. “The research team found that perceived social isolation—the ‘feeling of loneliness’—was strongly linked to two critical physiological responses in a group of 141 older adults: compromised immune systems and increased cellular inflammation. Both outcomes are thought to hinge on how loneliness affects the expression of genes through a phenomenon the researchers call conserved transcriptional response to adversity, or CTRA. The longer someone experiences loneliness, the greater the influence of CTRA on the expression of genes related to white blood cells (aka, leukocytes, the cells involved in protecting us against infections) and inflammation. A lessened ability to fight infections along with a slow erosion of cellular health leaves the body open to a host of external and internal problems, some of which worsen over time with few distinct symptoms.” The researchers said the results were specific to “perceived social isolation” and were unrelated to stress and depression.

Fifth retraction for former Baker IDI heart researcher

Retraction Watch reports that JAMA has issued a second retraction for former Baker IDI Heart and Diabetes Institute researcher Anna Ahimastos. In September, JAMA announced that Ahimastos had “fabricated [records] for trial participants that did not exist” in a trial for a blood pressure drug. That trial was retracted, along with a subanalysis. The second paper — Effect of perindopril on large artery stiffness and aortic root diameter in patients with Marfan syndrome: a randomized controlled trial — has been retracted at the request of Ahimastos’ coauthors because it included data from the first discredited paper. The retraction is the fifth for Ahimastos, who has admitted to fabricating data for studies published in the Journal of Hypertension and Annals of Internal Medicine. Three more are expected.

WHO partly to blame for Ebola deaths

An independent group of public health researchers, published in The Lancet, has called for big changes to the World Health Organization in the wake of the 11 000 deaths from Ebola, Wired reports. Suerie Moon from Harvard, a co-author of the report, said: “Ebola was really a wake-up call. If we don’t get together to make reforms after something as devastating as Ebola, you really have to wonder when we will.” According to Wired “in the early days of the Ebola outbreak, WHO’s response was so lackadaisical it [messed] up even the chlorine — the disinfectant doctors got was expired”. The researchers called for a new WHO centre “dedicated to emergency outbreak response, and an independent commission that will hold the agency accountable for its actions”. WHO has since convened another group of independent experts to assess its response to the Ebola outbreak.

Naegleria warning in WA

In the wake of an episode of the ABC’s Australian Story program, the Western Australian Health Department has issued an official warning about the lethal amoeba, Naegleria fowleri, and the subsequent risk of Amoebic meningitis, Outbreak News Today reports. Australian Story told of the Keough family whose son Lincoln who died of the illness after playing in infested water from a garden hose. N. fowleri can be found in any fresh water body or poorly treated water. It thrives in warm water temperatures, between 28oC and 40oC. Amoebic meningitis only occurs if water containing active amoeba goes up the nose and then to the brain. The warning recommended swimming only in saltwater or chlorinated pools.

New president for RCPA

Dr Michael Harrison has been confirmed as the new president of the Royal College of Pathologists of Australia. Dr Harrison, who has been vice-president for the past 4 years, replaces Associate Professor Peter Stewart in the role. He has been a consultant pathologist with Sullivan Nicolaides Pathology for 30 years, first in their clinical chemistry and microbiology division and then as CEO and Managing Partner for the past 12 years.

A step toward facilitating ethics review of human research in Australia

One of the main obstacles for Australian researchers applying for ethics approval of their research has been the absence of an application form that can deal equally well with all research and, more importantly, simplify the application and ethics review process. Such a form would enable the consideration of the critical ethical issues related to a proposed research project by both the applicant and the reviewing committee. A fresh perspective on the ethics application process has been requested both by applicants and ethics committee members.

The National Health and Medical Research Council (NHMRC) has sought to respond to this need through the development of a concise, streamlined application form, supported by a contemporary technology platform, to facilitate efficient and effective ethics review for all research involving humans. The development of this form — the Human Research Ethics Application (HREA) — is part of a suite of initiatives funded through government budget measures to streamline ethics approval processes.

Designed with a new structure and logic, and with sophisticated filters that generate questions specific to each application, the HREA will assist researchers to consider how the ethical principles and standards that apply to their research will be addressed. We anticipate that the new form will be welcomed by researchers and reviewers alike, and will lead to more efficient human research ethics review and approval.

The continuing engagement of the research community and the ethics committees that support the research is integral to the development of this application. The NHMRC will soon be seeking feedback on a preliminary version of the HREA (https://www.nhmrc.gov.au). An initial launch of the HREA is planned for early 2016.

Is ketamine ready to be used clinically for the treatment of depression?

A single dose of ketamine produces rapid antidepressant effects, but attaining lasting remission remains a challenge

Some clinics in Australia and overseas have begun offering a course of ketamine treatments to patients with depression. However, this practice is premature, given that the efficacy and safety of this treatment approach has yet to be tested in controlled trials. Further, whether such a treatment approach leads to lasting response — that is, clinically meaningful effects — is as yet unknown. Ketamine differs from current antidepressant medications in that it acts primarily on the glutamate signalling system, rather than on the monoaminergic (eg, serotonin, noradrenalin) system. To date, eight randomised, placebo-controlled trials involving almost 200 participants with depression have shown robust antidepressant effects after a single, subanaesthetic dose of ketamine.1,2 These impressive clinical results have generated intense interest among researchers, clinicians and patients.

First, the onset of effects is much more rapid for ketamine than for other antidepressant treatments, with peak effects seen 24 hours after receiving a single treatment, in contrast with the several weeks required for most other treatments. Second, ketamine has a very high efficacy, as demonstrated by high overall remission rates,1 efficacy even in patients who are highly treatment resistant,3 and one preliminary report of superior efficacy to electroconvulsive therapy, typically considered the most effective proven biological treatment for depression.4 These observations have driven public demand for ketamine to be immediately made available as a clinical treatment for depression.5

However, a major drawback of this otherwise impressive treatment is that antidepressant effects typically last for only several days after a single treatment.6 The occasional patient may attain a lasting remission after a single dose;7 but, as yet, there is no way of identifying which patients will gain lasting benefit from a single treatment. Several strategies have been trialled in attempts to prolong the antidepressant effects of ketamine, but none have resulted in lasting improvement. The main strategy has been to give repeated doses of ketamine. Preliminary trials suggest this may prolong the antidepressant effects from a few days to a few weeks.8 So far, the efficacy and safety of repeated dosing has not been tested in placebo-controlled trials.

Risks of acute treatment with ketamine include induction of psychotomimetic effects and elevation of blood pressure. These are transient, occurring mainly in the first hour after treatment. Ketamine has been given safely to patients in clinical trials, in which patients were first carefully assessed in terms of hypertension, cardiac function, hepatic function and psychiatric illness, and with careful monitoring and constant supervision in the immediate hours after treatment. Longer-term use is associated with different risks, and the safety of ketamine with repeated treatments is unclear. Data on chronic use come largely from recreational users; that is, the data are unsystematic and uncontrolled. What evidence there is suggests a risk of hepatic impairment, bladder dysfunction and, possibly, cognitive impairment. 9 Until there are clear data on these risks, repeated treatment doses should be given within a framework of systematic evaluation of these adverse effects. Another important consideration is the risk of inducing craving for further ketamine in patients treated with the drug. Although research participants evaluated 6 months after participation in strictly controlled treatment trials for depression have not shown increased craving for ketamine, there is a cautionary report of ketamine tolerance and addiction developing after its use to treat depression.10 In this report, increasing doses of ketamine were used in an attempt to obtain lasting antidepressant effects, resulting in considerable adverse effects and eventual requirement for detoxification from ketamine, with resultant lapse into severe depression.

Other considerations in the use of ketamine as a treatment for depression include the optimal route of administration and dosage. Most clinical trials to date have administered 0.5 mg/kg ketamine over a 40-minute intravenous infusion. Ketamine has also been given by simpler methods: orally or sublingually, by intramuscular or subcutaneous injection, and by intranasal spray, with some studies reporting similar results to studies using an intravenous route.7,11–13 It is also unclear whether 0.5 mg/kg, the dose selected for initial trials and used in most subsequent trials, is the optimal dose level. To date, there have been minimal investigations of the important pharmacodynamic considerations of treatment route and dosage, and how these may determine the magnitude and persistence of the antidepressant response.

Given the current evidence and risk of potential harm, it is not surprising that recent actions have been taken by health authorities in Australia to curtail medical practitioners offering a course of ketamine treatments to patients with depression.14 If ketamine is prematurely applied clinically to treat depression, before research has determined how (and if) it can be effectively and safely used to achieve lasting remission of depression, the end result may be disillusionment and even abandonment of this otherwise promising therapy.

Welcoming the new Editor-in-Chief

From 1 December 2015, Laureate Professor Nicholas Talley has assumed the role of Editor-in-Chief at the Medical Journal of Australia.

As one close reader of the MJA, I cannot imagine anyone in Australia better qualified than Professor Talley to head what I choose to believe is the leading medical journal in the southern hemisphere. Professor Talley’s many affiliations will, I am sure, strengthen the Journal in arenas national and international. I congratulate him on his appointment and wish him, together with all Journal staff, the best of fortune for coming years.

It has been a great privilege to serve the Journal over recent months. I thank all staff at the Journal for advice and assistance. The Board of the Australasian Medical Publishing Company, chaired by Mr Richard Allely, and the President of the Australian Medical Association, Professor Brian Owler, have also provided unqualified support, so I thank them too. As a consulting editor, Professor Jeffrey Zajac has also contributed during the interval between Editors-in-Chief.

As a refereed journal, our warmest gratitude to our dedicated reviewers: they are listed here.

I am grateful for the experience of editing the MJA: there is plenty to learn.

My best wishes to all readers of the MJA. The future looks bright indeed.

Manuscripts received 2014–2015


Manuscripts	Accepted	Received	% accepted
Total	335	1164	28.8%
Research	56	444	12.6%
Cases	27	263	10.3%
Editorials	44	51	86.3%
Perspectives	71	157	45.2%
Letters	112	206	54.4%
Short reports	25	43	58.1%
Mean days to decision	Total	Research
To accept		37	137
To reject		22	23
Reviewers used			817
Impact factor			4.089

Building on the rich heritage of the Medical Journal of Australia

The Medical Journal of Australia is without doubt the most important general medical journal in Australia, with a history dating back over 100 years. It is therefore a great honour and privilege to commence as your new Editor-in-Chief.

My professional interests span clinical practice, medical education and research, medical leadership, health policy and social justice. My goals as editor are to build on the outstanding DNA of the Journal, further increasing its relevance and readability, and attracting the highest quality submissions. We will aim to build on the Journal’s rich heritage by continuing our practice of publishing the best clinical science papers that have the potential to transform practice, including clinical trials and comparative effectiveness research. We will also aim to inform readers on advances in medical education, and cover issues from medical leadership to re-engineering our health system. We will continue to seek expert reviews, editorials and commentaries, meta-analyses and guidelines, and the latest news and information that everyone in practice needs to know. It is my goal to reinforce the unique role that the Journal plays as the pre-eminent publisher of Australian medical research and as a vital platform for translating research into practice, as well as helping to inform the broader health policy debate. This is part of the Journal’s success and why it is relevant to clinicians, researchers and academics across the nation.

The MJA is prestigious and influential, but another advantage to publishing with us is that much of the content including our research content is published freely on our website at mja.com.au, without the waiting period often imposed by other journals. I can also assure readers that as Editor-in-Chief, I have a guarantee of editorial independence and I will fiercely guard this independence on your behalf. For the nearly 32 000 subscribers who receive the MJA in print, and the many others who read the Journal online, the team will work tirelessly to provide the best medical journal experience possible.

We live in a world that, in terms of connectivity through social media, is rapidly shrinking, and the MJA has an important role to play not just nationally but globally. We will therefore now be encouraging locally relevant international articles. And we will continue to tackle in our pages articles that highlight the tough health issues we all face and provide possible solutions, from the health needs of Indigenous Australians to the health impacts of global migration, population growth, dwindling resources, an ageing population and climate change, to name a few. We will look both out to the world and across Australia to find the objective data that can help guide us all. We will seek balance among the many expert opinions and will aim at all times to be rigorous, evidence-based and transparent.

Whether any of us like it or not, our performance in medicine is being increasingly measured and critiqued, and it’s no different for medical journals. Clinicians and academics want to publish in the best medical journals and one metric applied universally is the impact factor, calculated by counting the mean number of citations received per article published during the previous 2 years. In the best journals, editors arguably “live and die” by the journal impact factor published each year. The impact factor is flawed (some argue fatally so) and is not used by the National Health and Medical Research Council; but it can’t be ignored either!1,2 In 2015, the MJA, your national journal, ranks in the top 20 general medical journals worldwide and has a highly respectable impact factor of 4.089 (Box, previous page). I am pleased to say that the impact factor of the MJA has risen and I anticipate over the coming years that it will continue to rise (as will other metrics of excellence) as we further increase the quality and reach of what we publish.

We welcome your best work being submitted for consideration. Our acceptance rate is currently falling (as marks all of the best medical journals) but I can pledge that your medical articles will be expertly peer reviewed and edited before publication. The editorial team will do its utmost to ensure it makes the best possible decisions, and we will work hard with authors to help them publish polished, excellent contributions.

Finally I would like to acknowledge and thank Professor Charles Guest in his capacity as Interim Editor-in-Chief for his stewardship of the Journal in the second half of 2015. He has been instrumental in supporting our editors and maintaining the continuity and the quality of the Journal.

Thank you for reading the MJA. You can expect that the Journal will be further increasing its scientific reputation and international presence over the next few years, and I hope you will be part of it if you have a contribution you wish to make. We welcome suggestions and feedback so we can further improve the Journal on your behalf. I am committed to strengthening your clinical practice through its pages and look forward to our journey together.

Box –
MJA impact factor, 2009–2014