A message from the President

Your Future is Our Board’s Focus

Through the lens of reflection, the College’s Board of Directors must appear like a distant planet to some members. They ask: What do those creatures up there know about life down here—and, more to the point, do they care? Well, our directors know quite a lot about your world, and they also care, but there is certainly scope for clearer communication across the void.

With this in mind, I thought I would use this message to address two matters: one is an initiative aimed at improving how the Board and the College as a whole represents the professions and presents itself to the outside world; the other is a brief overview of how the Board operates behind closed doors on behalf of all members. Both are complex in the details but easy to grasp in outline.

The Board has established a task force to advise it on ways to improve the College’s policies and processes to address shortcomings in who we recruit to our specialties, the environment within the College for members and employees, the representation of minority groups in the College leadership, and the furtherance of an inclusive culture in the College.

These are big issues that go to the heart of who we are and who we want to be in the future. The diversity, equity and inclusion (DEI) taskforce will report directly to the Board on long-standing issues such as women in radiation oncology and clinical radiology, and more contemporary policy issues such as the representation of transgender and genderdiverse people in the membership and their health care in the community at large. Some members have argued this is not core business for the College. I beg to differ. By acknowledging existing deficiencies and rectifying them, we will evolve into a better and more inclusive organisation.

Women comprise more than half of all medical graduates but only a third of clinical radiology trainees, a proportion which has barely changed in the last 15 years. We know self-selection due to personal preference plays a role, e.g., 55 per cent of paediatricians and gynaecologists are female, which we accept as ‘natural’, while 70 per cent of pathologists are female, which may be due to a favourable work-life balance for working mothers. But how many women are lost to radiology because of inequities and arbitrary barriers to their participation in our specialties? And how well does the College represent women in its leadership? Currently, we have just one woman on a board of eight directors. Part of the taskforce’s objectives is to better understand what the percentages mean and whether we need to do more.

Other medical colleges have already gone down the path of addressing their DEI issues and, with varying degrees of success, they have developed policy statements. Unfortunately, the debate tends to the nebulous, with some using the terms, diversity, equity and inclusion almost interchangeably. That’s not a prescription likely to calm the sceptics.

Equity is about dealing with people even-handedly, that is, with impartiality and fairness. An organisation that acts equitably does so without bias or prejudice towards others and its constituents, and in accordance with its stated principles and purpose. Diversity in an organisation is about ensuring that its constituents are varied and different in character or qualities. A diverse organisation comprises people who are not all or predominately the same, for example, in their gender, race, sexual orientation or able-bodiedness. Inclusion is about being open to and respectful of the views, talents and needs of the whole constituency. An inclusive organisation gives every member a fair say and allows all to have access to its opportunities and resources.

These organisational virtues often coincide in work settings, but they are not interchangeable. An organisation may lack diversity and show little respect for a minority within its ranks, but still act with impartiality and fairness in the wider community. An organisation may have a diverse membership and respect the views of all but act unfairly with bias towards some members. And so forth.

Building a college that is visibly and explicitly equitable, diverse and inclusive is more than window dressing or virtue signalling seeking to shield us from criticism on social media. The goal is to make the organisation as representative as possible, manage our operation effectively on behalf of all members, and attract and retain new members with the knowledge, skills and sensitivities to secure the trust of every patient and serve that patient well. These objectives should be cause enough to support the work of the proposed taskforce but there is even a bigger potential benefit. Many believe the initiative helps to overcome broad social inequalities, especially those associated with access to health care. Such a goal should always be at the moral centre of our work as medical practitioners.

The second matter is about the makeup of the Board and the nature of its deliberative processes. In the world of corporate governance, boards such as ours do not operate in a parliamentary manner, with elected vote carriers for the vested interests of different factions in the membership.

The College’s Board is regulated by the Corporations Act and the governance standards of the Australian Charities and Notfor-profit Commission. Under these laws, directors (including non-member directors) carry a legal obligation to act in the best interests of the organisation as a whole and on behalf of the entire membership. Even where a board has directors appointed to give voice to the views of a particular section of the membership—on our Board we have the Deans of the two faculties and a representative of our New Zealand members— these directors’ duties are to the organisation, not the section from whence they arose. That is, the Board is compelled to operate collectively and with a degree of solidarity, akin to the function of Cabinet in the Westminster system, where ministers are expected to publicly support decisions they may have argued against in Cabinet. Any director who has a conflict of interest must disclose that conflict and manage it appropriately, which may mean taking no part in the decision by the Board.

Boards that forget these rules of governance do so at their peril. It’s not unknown for boards to degenerate into factional battlegrounds with a group of directors voting as a block, leading to ineffective management and damage to the organisation as a whole.Our Board has avoided that fate and my hope is that it stays that way.

The College’s Board may sometimes appear a long way off in its thinking but that’s an optical illusion. Look up, your future is our focus.

References

1 Australian Tax Office, Taxation statistics 2019–20, table 14.

2 For example, https://ranzcog.edu.au/wp-content/uploads/2022/04/ Gender-Equity-and-Diversity-Policy.pdf

3 See https://www.aicd.com.au/content/dam/aicd/pdf/tools-resources/ nfp-governance-principles/06911-4-ADV-NFP-GovernancePrinciples-Report-A4-v11.pdf