Introduction
The scale of regulatory reviews that medical colleges in general are having to deal with in 2024 has been numerous. This has seen the Royal Australasian College of Surgeons (RACS) increasingly engaged in the advocacy space on behalf of our members.

It has been an unusually busy year, and RACS has been at the forefront advocating for regulatory reforms through consultations throughout 2024. This is to ensure that the future of surgery in Australia reflects the very best standards and safety, and within sustainable workforce practices. RACS has been liaising actively with the policy and regulatory frameworks for the betterment of its members, the surgical workforce, and the patients they serve.

Here are six key reviews and consultations.

1. Unleashing the full potential of our health workforce - scope of practice review
The review by Professor Mark Cormack into the scope of practice by our health workforce led the Department of Health and Aged Care to look at how primary healthcare practitioners can better use their skills for improved patient care. RACS has been engaged in this review—advocating that surgical practitioners are working within their appropriate scope to ensure patient safety and continuity of care. While RACS supports the concept of multidisciplinary collaborative care, it reinforces that complex surgery must be the exclusive domain of FRACS. A final report was released in October 2024.

2. Working better for Medicare review – workforce distribution levers
This review of the Medicare workforce distribution is put forward to address the maldistribution, particularly in rural and remote areas. RACS emphasised the value of rural pathways for surgical Trainees and continued support and RACS oversight for FRACS and SIMG surgeons in these areas. RACS calls for more robust retention and attraction models, which include private practice opportunities and interdisciplinary training collaborations.

3. Rural Generalist Medicine Recognition
RACS has supported the recognition of Rural Generalist Medicine as a protected title under general practice, recognising the important role it plays in regional health care. RACS considers that rural generalists should be embedded in professional networks with specialist surgeons to assure the highest levels of care in areas of need.

4. Regulation of Artificial Intelligence in Surgery
Given the growing use of Artificial Intelligence (AI) in this aspect of medicine, RACS has lobbied for further regulation under the Therapeutic Goods Administration. RACS has urged the Australian government to the amendments in the Therapeutic Goods Act to categorise surgical AI as a medical device, with proper pre-and post-market evaluations. With AI, there is the possibility for improved surgical outcomes. However, , there are challenges that include data privacy, algorithmic bias, and responsibility which require open oversight if public confidence in AI-powered healthcare is to be maintained.

5. NRAS complexity review
RACS supported the review of National Registration and Accreditation Scheme (NRAS), which had as its terms of reference the simplification of the accreditation and complaints handling processes. NRAS emphasised the responsive complaints system that needed to be provided to maintain patient safety and support Trainees and specialists. RACS warned of risks in centralising complaint management and asked for more direct and effective channels of complaint.

6. Urgent call to suspend Aphra’s fast-tracked SIMG pathways
The introduction of fast-tracked pathways for Specialist International Medical Graduates (SIMGs) by Ahpra has set off a range of alarm bells within RACS. While touted as solutions to workforce shortages, these pathways carry risks to surgical standards and patient safety. RACS with other colleges have called for an immediate stop to their implementation on various grounds—that the periods of supervision are not adequate, they have not been targeted towards areas of need, and some compromise on the quality of surgical care. RACS called for more targeted consultation and reform with the intention that SIMG pathways comply with Australia's standards for training and the needs of the workforce.

Conclusion
These reviews have been used by RACS as opportunities to reinforce its advocacy regarding reform to ensure that Australians have access to quality, safe, and equitable surgical care. RACS continues to work with government agencies, regulatory bodies, and key stakeholders in regard to any modifications within the healthcare landscape, handling change thoughtfully and in a manner which benefits both the surgical profession and the greater community. While these reviews remain ongoing, RACS is a continuing strong voice for its members in the call for reforms that will better shape the future of surgery in Australia.