Meet Veronica, a Medical Administration Registrar with the Northern Regional Alliance, based at Waitemata DHB in Auckland. She is a Royal Australasian College of Medical Administration (RACMA) trainee and the very first person to hold a position like this in New Zealand - all other RACMA trainees have already been in formal leadership positions. A true trailblazer!
I am the daughter of two GPs so grew up with medicine being talked about at home. My mother always had an interest in the health system and was on a couple of boards so I was exposed to a lot of the conversations and politics happening behind the scenes.
I did my training at Monash University and really loved learning about ethics and law at medical school. While doing my internship in Victoria, I was frustrated about how inefficient things were and how powerless I felt. I went to Google, as probably most people do when frustrated or disempowered, and came across RACMA. I realized quickly that is what I probably wanted to do but I did still think about having a clinical career at that stage.
I wondered how much of how I was feeling was the system and how much of it was me.
So, I moved to a different state and hospital and worked there. It made me realise that I really do like patients, but I wasn’t that interested in keeping up to date with medical practice. It is a lot of work and hard to do if you’re not passionate about it. And I wasn't desperately passionate about any particular field, other than health system science.
I initially applied to RACMA in PGY3 but decided I needed more clinical experience so I locumed in a lot of different areas for a few years, mainly as a medical registrar, making sure I got rural experience. It was also a good way to network – anywhere I went I would knock on doors. Because you literally never know who you will meet.
I moved to New Zealand with my partner for his job and was really lucky to get the first rotational Medical Administration Registrar job.
Can you tell us a bit about RACMA?
RACMA was established in the 1950s by doctors who realized they were expected to manage people and budgets but had no formal teaching in how to do that. The college curriculum is about training doctors to the theory, tools and techniques of management. It includes leading teams, managing budgets, how to change things and manage a big, complex service. It’s really, really interesting.
What I do
I work for the Chief Medical Officer and the Director of Planning and Funding – two members of the Executive.
I can be working on lots of different problems in different fields and I’m not usually the subject expert. There are no algorithms to fall back on here! So you have to rely much more on soft skills and being able to apply different leadership styles.
I think you need a lot of insight into what your strengths and weaknesses are.
I think you need a lot of insight into what your strengths and weaknesses are. For example, it can be intimidating for some people approaching someone more senior and trying to motivate them to want to change. You need to use your bosses and know when to practice at the edge of your comfort, as that is usually when you get the most development.
In medicine, you assess a patient, think about differentials, refine diagnoses and treatments plans over a few days then you discharge them and you don’t see them again until maybe an outpatient clinic or repeat appointment. You see results and make decisions relatively quickly. In medical administration, it can take years from the germination of an idea to embedding a change. As a doctor we often see the narrowest part of that process, the implementation. I get to see a lot more of the ‘behind closed doors’ stuff than I did as a junior doctor; you get a lot more insight into why decisions are being made. And you even get an opportunity to influence that sometimes! One of my main projects is around clinical governance, looking at the structure and priorities of the clinical governance board and trying to create a more consistent and streamlined approach across different services.
In big organisations, there’s always going to be parts that run smoothly and parts that don’t and I am fascinated by both. You can get caught up in doom and gloom and let high performing areas fall by the wayside. I have worked out that nothing is ever 100% terrible or 100% perfect and there is always improvement you can do. And that’s what I am really interested in.
My ‘average’ day
Honestly, I have not sat on my bum so much since uni! No more 3 hour ward rounds. I am generally at my desk or attending meetings, which I will need to prepare for in advance. I am always looking for ways to present objective data in a way that will demonstrate a need for change - my Powerpoint and Excel skills have really gone up! I have learned less is more most of the time.
I work with just about every specialty you can name, the community, patients and reaching out into NGOs - so well beyond the DHB. Because you're working with so many stakeholders, not just your own service, it can be really interesting and makes you appreciate the politics and competing demands within a large organisation.
In some ways it's a lifestyle specialty: I work Monday to Friday, get a lunch break every day and will never have to do shift work again. I can plan weeks, months, years in advance and say yes to things. It's awesome.
My experience of ‘going beyond’
What were the reactions from others when you decided to pursue a non-clinical path?
I think it's as true of anyone that ends up in a non clinical field, you tend to think you're a bit weird. But actually, when you talk to people who do literally anything other than medicine, maybe being a lawyer, you know, where it's less explicit and less of a treadmill and it’s quite normal to change paths.
Unfortunately, I think medical school and our medical training curriculum is incredibly blinkered; you have done medicine, you must treat patients. There are a lot of medical graduates out there not treating patients and you don’t meet them as a junior doctor. The people around you are biased by their experiences; they don’t see colleagues working in medical insurance or as management consultants.
There are a lot of well-meaning people. There are always a couple of people who think it is shameful to be anything other than a clinician but actually they are the tiny minority. A lot more people will be discouraging out of naivety. You get a lot of people, particularly when you ask around hospitals, who have very limited understanding what else is possible. So that's probably not the best place to be asking.
Even my parents who are doctors were worried. It was actually their friends in completely different careers who I found most supportive as they could be objective. So don't let people tell you that you can't. You can. It's not easy but there are plenty of people that have.
So, don’t let people tell you that you can’t. You can. It’s not easy but there are plenty of people that have.
Is there anything you wish you had known before taking on the role?
I think I was a bit naïve about the hierarchy. I knew I'd have to tread lightly but it's been quite surprising how differently you are treated when moving sideways - because I'm still a registrar. When I was a medical registrar speaking to a different head of department I would still get treated with a particular degree of respect because they understand my role. Despite the power differential there's a trodden path for how those conversations go.
As a Medical Administration registrar there is no trodden path, you are very much an alien entity, especially in New Zealand. And when people are confronted with something unfamiliar, they can have a strong reaction and it is not always a positive one. So that is the one thing I would warn people about.
The warmth with which I am welcomed by so many other professions is overwhelming.
Interestingly, the warmth with which I am welcomed by so many other professions is overwhelming. I still have that imposter syndrome - why are you listening to me, you are senior nurses and are brilliant and so smart? Yet, they're asking me for my opinion. And so you open up this wonderful world of people who are excited to speak to you, and you get avenues to speak to them.
If someone wanted to pursue a similar role, how could they go about it?
RACMA is in its infancy in New Zealand. There will now be one position per year in Auckland for a Medical Admin registrar but there are only a handful of trainees around the country so your support network is a bit limited. If you are not in Auckland, your best bet is going to speak to your Chief Medical Officer (CMO) and exploring the possibilities. If you are already in a formal leadership position, like a clinical lead, you may be able to accredit that position with RACMA so it is worth getting in touch with the college to ask them.
Australia is quite a bit further ahead (there are multiple Medical Administration Registrar roles across the country). But it is not yet that competitive, so you have a good chance, especially if you are flexible with location.
You can get all of the same experiences without the RACMA training but you do miss out on the rigour of the programme, it really is an outstanding curriculum so you don’t have to learn the hard way on your own. It also gives you a stamp of approval with others.
Skills & Experience
You have to be interested in data as a way of providing evidence to the decisions you are making or changes that you are proposing.
They are generally looking for people with broad experience that are fairly independent. They are not looking for the best medical registrar or most technical surgeon but want to see that you have a sense of the bigger picture and an awareness that the way you have been working may not be the only way. You need to understand that things work differently in different places and there can be strengths and weaknesses to any given approach. One way to demonstrate that is to work in lots of different places and have tried different things.
Part of the RACMA curriculum is doing a Masters in either Public Health or Health Services management. That’s a good thing to do whether you are set on medical admin/leadership or not – it shows you are interested in the system and arms you with a lot of skills. However, you may get that funded as a RACMA trainee so if you are seriously considering that pathway it is worth negotiating with your DHB.
There are lots of other courses you can do. Be confident and go and chat to someone in the finance or legal department - ask them if there are any good conferences or online resources they can point you to. It’s also a great opportunity to network. The Khan Academy has some great, free online training.
If you could go back to your medical school graduation day and give yourself one piece of advice, what would it be?
Be patient. When you go through medical school most things are within your control. You decide whether or not to go to lectures and grades are mostly a reflection of your own efforts. As you move through your career, just deciding what's going to happen, doesn't make it happen. And your priorities aren't always the same as everyone else's. And so learning to accept what you can control and then just allowing the rest to happen around you and focusing on what is within your control is, I think the best approach to everything. Be confident letting things go when they're not within your control. And if it doesn't feel right, don't do it.
And if it doesn’t feel right, don’t do it.