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20 Jun 2016

Equity. It’s all the rage these days. Companies, organisations and individuals in positions of authority and leadership are practically falling over themselves to espouse their want for a world free of inequity.

And indeed, if you speak to most people about the world we live in, they’ll be quick to point to the social advances of the last few decades as evidence for why things aren’t really that bad. “We’ve come a long way!” they’ll say. “Things aren’t that bad!” “It’s never been easier!”

Thing is though, nobody ever seems to ask those who are in positions of inequity. Or at least, if they do, they never make the headlines.

They don’t enjoy the same position of power in society and therefore don’t get the big PA microphone and the soapbox from which to pronounce the end of inequity as we know it. This matters to doctors because we know all too well that inequity is alive and present. We see it in our emergency departments, we see it in our rooms and we see it in our communities. As said by Rudolf Virchow and so eloquently recalled by my colleague, AMSA President Elise Buisson at the recent AMA National Conference, “the physician is the natural attorney of the poor”.

So let’s accept that there are palpable inequities in today’s society, and will most likely always be, in one form or another. Let us also accept that most people recognise these inequities and would fix them if they only knew how.

It’s hard to believe that the majority of people are genuinely that evil. Much like the glacial pace of innovation in health care, it’s more often the case that the systems we’ve built are the machines of harm, filled with people constantly striving to minimise the damage.

So, where to begin. Thanks to a mother with an incredible bullshit filter (never could quite pull the wool over her eyes), I’ve in turn become someone who respects actions rather than words. The AMA Council of Doctors in Training recently met with the Australian Indigenous Doctors Association (AIDA) to discuss vocational training and what can be done to help Indigenous pre-vocational doctors transition through to fellowship.

It’s one thing to recognise that we don’t have enough Indigenous doctors in Australia to have a truly representative workforce, but it’s another to implement measures that result in graduating fellows. To this end, we plan to work with AIDA over the coming year to identify how to best support Indigenous trainees through their training, and ensure cultural safety in the workplace. We want to celebrate initiatives such as the Royal Australian College of Surgeons Reconciliation Action Plan and scholarships for Aboriginal and Torres Strait Islander SET trainees.

We want to recognise the Australasian College of Dermatology for offering a designated Aboriginal and Torres Strait Islander training position, with support to complete their training.

We want to help the other colleges follow suit. Ideas like this might not be ground-breaking and they might not be sexy, but they achieve results. Only a workforce with Indigenous doctors as leaders can truly serve a population like Australia. 

We can argue about equality and equity for an endless amount of time, but I notice a common thread when we do.

It seems that we all too often focus on our own personal perspectives when we consider inequity, rather than the systemic issues that cause the inequity in the first place. We cage our defence in language around “free loaders”, “dole bludgers” and “queue jumpers”, to justify why inequity exists in the first place. We can keep doing that, and it will be to our own detriment.

Alternatively, we can focus on removing systemic barriers in our workforce, our community and our personal lives. I’d much rather see the results of a fair race, and just how far forward that race can take our profession.


Published: 20 Jun 2016