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April 11-13, 2019
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Australia is officially
the Commonwealth of Australia, and includes the mainland of
Australia, the island of Tasmania and several smaller islands. The
capital of Australia is Canberra, although Sydney is the country's
largest city. Australia is approximately 2,969,901 square miles,
and has an estimated population of 23 million. Australia has a
publicly-funded universal health care system, known as Medicare,
which was introduced in 1975. The universal health care is funded
by an income tax surcharge which is currently set at 1.5%. The
hospitals and outpatient services are managed by the states. The
Commonwealth provides subsidized prescription drugs to Australian
residents and general practice services.
The Royal Australasian College of Physicians (RACP) is a
professional organization responsible for training, educating, and
representing over 14,950 physicians and paediatricians and 6,500
trainees in 34 medical specialties in Australia and New Zealand.
Specialities include paediatrics, cardiology, respiratory medicine,
neurology, oncology, public health medicine, occupational and
environmental medicine, palliative medicine, sexual health
medicine, and rehabilitation and addiction medicine. Members of the
RACP work across medical specialties in hospitals and communities.
The RACP aims to improve patient care and reduce illness in the UK
and around the world.*
* source: Wikipedia.
What inspired you to become a physician?
When I was a medical student, I was inspired by the residents
and fellows on the services I attended when training in medicine
and surgery. They were the glamorous young doctors who seemed to
know almost everything. My father, a gastroenterologist, was also
an inspiration to me, although his name is also Nick Talley which
has caused countless confusion.
I wanted to specialize but I was not sure which speciality to
choose. Being left-handed, I didn't think I would have good enough
hands to become an expert surgeon, although I liked operating. I
did want to become an expert diagnostician, and I liked
communicating with patients, applying clinical skills, solving
complex problems and managing diseases. Originally, I thought that
I wanted to be a neurologist but despite resisting the temptation
initially, gastroenterology prevailed because it is a hands-on and
highly cognitive specialty. So today there are two Nick Talley's,
both gastroenterologists, at one time were in the same city, and
yes, we have been confused.
What do you enjoy about being a gastroenterology
subspecialist, with a major interest in medical
I see general gastroenterology patients and perform endoscopies
but I am also a subspecialist with a major interest in
neurogastroenterology. I'm interested in common and rare
neuromuscular gut diseases, so I am a "gut neurologist." I see
patients from all over the country. I like to teach residents and
fellows how to manage the most complex gastroenterology issues.
My research work has focused in part on functional gut diseases
which we now know often have an organic (e.g. inflammatory) or
sometimes a genetic basis. I have also undertaken research into
other inflammatory gut diseases such as eosinophilic esophagitis
and celiac disease, and chronic gut infectious diseases (e.g. H.
pylori). My group has identified new diseases (e.g. eosinophilic
duodenitis linked to functional dyspepsia) and new mechanisms (e.g.
genetic basis of functional gut disease).
I remain passionate about teaching clinical skills and continue
to emphasise to all who will listen that a good history, rather
than ordering hundreds of tests, is usually the method required to
accurately diagnose and effectively manage our patients.
Can you describe the role of the Royal Australasian
College of Physicians (RACP)? What are the mission and goals of the
The Royal Australasian College of Physicians (RACP) trains,
educates and advocates on behalf of more than 14,950 physicians and
6, 500 trainees across Australia and New Zealand. The College
represents more than 34 medical specialities including paediatrics
and child health, cardiology, respiratory medicine, neurology,
gastroenterology, oncology, public health medicine, occupational
and environmental medicine, palliative medicine, sexual health
medicine, rehabilitation medicine, geriatric medicine and addiction
Beyond the drive for medical excellence, the RACP is committed
to developing health and social policies which bring vital
improvements to the wellbeing of patients and our communities.
What motivated you to become involved in the RACP and to
take on the role of President?
After returning to Australia from the Mayo Clinic in Florida,
where I was Chair of the Department of Medicine, I became deeply
interested in contributing to physician education and standard
setting in Australasia, and in public policy issues relevant to
health. I was approached by senior colleagues to stand for election
as president of the RACP. After careful deliberation, I decided to
throw my hat in, despite a very strong field. I never expected to
be President and remain deeply honoured to have been elected.
What would you like to accomplish as RACP
The breadth and depth of the RACP fellows and members is its
greatest strength. When I was running for president, I publically
declared my interest in a reform agenda. I emphasised the need to
champion physician training, further strengthen general medicine,
increase our advocacy on important public health issues, support a
social justice platform, lobby politically where appropriate, and
grow our national and global impact. My goal has been to ensure the
RACP is a highly relevant national flagship organisation, attuned
internally and externally. Much of this ambitious agenda has been
achieved or significant progress has been made. For example, we
have campaigned tirelessly on behalf of the health of asylum
seekers, the health impact of climate change, the societal impact
of binge alcohol drinking, the potential risks of e-cigarettes and
issues around legalization of medical marijuana, and have
demonstrably influenced public debate and the legislative agenda on
these issues. We successfully underwent external accreditation of
physician training by the Australian Medical Council, achieving
excellent results with the maximum six-year accreditation being
granted. We have supported medical research including providing new
grant schemes and worked on models of care for indigenous health.
And we have initiated a clinician-led evidence-based program called
EVOLVE aimed at re-engineering the health system to deliver the
highest quality and safest care sustainably.
What is the role of the internist in Australia? What are
the education and training requirements needed to practice internal
medicine or one of the subspecialties of internal
After completing the internship, the internists train for six
years in Australia and/or New Zealand, longer than internists in
the US. We call internists "general physicians" in Australia. All
specialist physicians do three years of general medicine then
subspecialize for another three years. More of our trainees have
opted to become general physicians in recent years and more are
dual training in general medicine and a subspecialty such as
gastroenterology or pulmonology, which is a seven year program.
What are some of the most significant challenges that
physicians in Australia face? What are your thoughts on the best
way to meet those challenges?
We face many challenges as physicians in Australia. One of the
biggest challenges for the profession is the capacity to train as
we have increasing numbers of medical students coming through and a
finite capacity to train them all. Balancing quality of training
with supply (selection into training) is an issue we are working to
solve in collaboration with the health system and governments.
Anticipating future workforce requirements is challenging in cities
and in rural and remote locations. We are working to acquire the
necessary data to inform our approach and influence health policy
makers. Strengthening general medicine is part of the solution.
Rising health costs affect all western nations. The aging
population and the burden of chronic illness on our health system
will require new models of care. Physician-led reform must be part
of the solution and through EVOLVE we are working to find new
solutions. Achieving equity in health, especially for indigenous
Australians, including improving life expectancy rates, and
improving refugee health remain ongoing policy areas. The issue of
global climate change also poses great challenges as evidence of
the potential health impacts continues to grow. Physicians and the
medical profession more generally have a responsibility to mitigate
these health impacts and that is why the RACP has taken a lead role
on this issue to raise awareness and encourage our profession to
take heed of the evidence and act.
What can other countries learn from your health
Australians enjoy long life expectancy and health costs are
relatively controlled. We have a very good health care system
combining public and private components, with underlying universal
health insurance paid for by taxes. National public health
strategies and strong primary care applying a gatekeeper model are
critical for the systems success. A key challenge for us remains
fragmentation of the system with division of responsibilities
between the federal and state governments. Rising hospital health
costs will need to be addressed with new models of care and better
approaches to managing chronic comorbidities in the community will
What have you found to be the most rewarding part of
leadership? The most challenging?
The ability to influence positive change in the community and
encourage discussion and debate about the social impacts of several
major health issues such as indigenous health and asylum seekers
has been the most rewarding part of leadership.
It is too easy to dehumanise the plight of others such as people
fleeing persecution. It has been challenging to provide an
effective voice for disadvantaged communities but leading the
challenge is, in my view, a key part of the role of a medical
November International Newsletter