Farewell from Outgoing President: Dr Lance Lawler

This is my final newsletter. After four years as President and nine on the Board it is time to hand the baton on. I have enjoyed my time, for the most part, it has been a privilege to hold this position and represent our profession. Four years ago, I listed what I thought were the biggest threats to our profession. It seems appropriate to revisit these.

Only a few years ago everyone was predicting the demise of radiology as a 'human' specialty, AI was coming and was so much better. We even saw a drop in applications for training positions (now reversed). However, from being the bogey man AI is now an exciting powerful tool that is going to make us super doctors. Yes, we have a long way to go, we expect difficult regulatory challenges, but the work we have done in AI—our committee, conference, ethical standards (a world first), the large AGM AI presence—has established the College at the forefront of Australian and New Zealand medical colleges in this field. We must work hard to stay there.

Increasing scope of practice of nurses, radiographers and sonographers into radiologist and radiation oncologist areas worried me for a long time, especially the work coming out of the NHS where it seemed anybody could do a course and report medical images. It's not that operating at the upper level of your training is bad, but it's hard to understand the impact this will have on our own work days, and the quality of work. My perspective has evolved. While I still have an issue with anyone reporting a medical image without proper training (and will continue to fight for this), there are some things that can be done perfectly well by non-radiologists. Nurses have been placing PICC lines for many years, very successfully. I know I may be burned at the stake for saying this, but some radiographers and sonographers are very capable of learning procedures and safely performing them in a team.

The powers-that-be know we cannot train enough future specialists and if we refuse to engage in this space we will simply be bypassed: a very bad outcome.

Other specialists entering the imaging field is another headache, not because they cannot do it, but because they tend to think they are better at it. Our experience in training and certifying imaging and oncology specialists has been hard won. The College is known for producing world-class, highly sought-after specialists. Why then, when cardiac CT became prime time, were we sucked into believing that radiologists and cardiologists needed the same new training and logbooks. I defy anyone to explain to me why a radiologist has to report 150 supervised cardiac CT cases to do one on their own, but you can jump into any other CT angiogram study without a hesitation. That's what we are trained for. When CT PET scanning arrived, somehow nuclear medicine physicians could pick up CT reporting after a weekend course, but radiologists need to do a two-year fellowship to report the PET component. We were caught off guard. My view is that the College is quite capable of deciding what, if any, extra training our specialists need to pick up any skill, and we need to assert ourselves a lot more. Let’s learn from our mistakes, and maybe we will be able to redress them.

Radiologists and radiation oncologists are easily overlooked, sometimes on purpose. The 'doctor's doctor' or the 'hidden specialty', we have traditionally been an easy target—everyone knows how to do our job better than us and are only too willing to advise policy writers and funders. The College has two main areas of responsibility: training and assessment (pre and post Fellowship) and standards of practice. We have delegated powers for the former, basically what we say goes (as long as we follow the rules), for the latter we can only provide advice. This advice space can be very crowded.

Four years ago, we decided that we needed to beef up our advocacy capabilities, so that we could make ourselves heard more clearly and more often, to become the trusted advisors in both medical imaging and our therapeutic specialties (IR, INR, radiation oncology, theranostics). I believe we have made good progress. We are able to access decision-makers more regularly, and they seem inclined to listen to us more (not enough though unfortunately). A word of warning, it is imperative that we are not seen as a trade organisation, as any whiff of self-interest rather than what is right for our patients sets us back. If we manage our conflicts of interest openly and properly, we will end up as an influential ally for future healthcare leaders.

Ironically, despite these external challenges, the hardest part of this role is managing internal conflicts. Our organisation runs on the freely given energy, enthusiasm and expertise of our members. I have regularly been in awe of how hard some of you have worked to advance our professions. On the flip side, we can be an opinionated bunch, so differences of opinion are inevitable, leading to all sorts of conflicts and headaches. Ultimately it seems it is always the 'College's' fault—as that dark overlord ruled by no name henchmen, at least that is what is often implied. I know members really want to call out the President and the Board but they are usually too polite (and almost always have the wrong end of the stick). For the record, in my experience, the presidents and the Board only have the professions’ best interests at heart. If you disagree with some calls, that's ok. If you want to influence things, run for a director's position. However, be very clear on your motivations—as long as our goals are to better serve our communities, referrers and patients we will do well.

My time as President has overall been a pleasure.

I have immensely enjoyed getting to know so many of you and sharing your stories and views. I have gained many friends, here and internationally, and look forward to catching up with everyone when we are finally allowed to travel again.

We have some great success stories to be proud of, some took a bit longer than expected (I am talking about the training and assessment reforms, a graveyard for well-meaning souls but also a triumph of perseverance for those who stuck it out). We are on the cusp of a major step change in our training and exam processes and systems. We are very well placed for the future.

From a complete vacuum on Indigenous issues, we have now a well-formed and functional Māori, Aboriginal and Torres Strait Islander Executive Committee, ably chaired by our Board's independent director, Prof Vin Massaro. This is a strong platform for us to address the institutional flaws preventing us from achieving much better healthcare outcomes for Indigenous populations. I have high hopes for MATEC. We have made good first steps in defining our interventional specialties This has been hampered over the years by strong differences of opinion by members, but we are now on the right path. This is a significant step for our interventional colleagues who are falling behind the other procedural specialties in their ability to deliver end-to-end care.

There are many other good news stories, including collaboration with the The Royal College of Radiologists over clinical guidelines (work in progress), working with the Department on e-referrals, addressing inequitable MRI funding/access, cementing the College’s role in redeveloping the Cancer Australia Plan and the new health reforms in New Zealand. Too many more to list.....

I want to pay special tribute to my Board and the CEOs I have had the pleasure to work with. Natalia, Mark, and now Duane have all been effective leaders and made a difficult job easier. I wish Duane all the best, everything I have seen so far reassures me we have made an excellent choice.

To the Board members, who see the best and the worst of the College, your considered thoughts have made us a better organisation.

I will miss our regular meetings (or will I...?).

A special mention to our College staff, without whom nothing gets done (you do not get enough credit); and of course to you, our members, without whom there is no College. I look forward to a beer or two with you. All that remains is to wish Sanjay luck— my advice is not to sweat the small stuff (there is too much of it).

Dr Lance Lawler

RANZCR President 2018−2021