Why are organisations originally built to represent medical standards and training increasingly operating like large corporate entities focused on perpetual institutional growth?
At the precise moment specialist medicine is losing control of the political narrative around healthcare, medical colleges are accumulating asset portfolios exceeding $1 billion.
While doctors continue doing what they have always done – caring for patients, carrying risk, running practices, staffing hospitals and absorbing the emotional and financial pressures of modern healthcare – a very different story appears to be unfolding inside the institutions supposedly created to represent them.
My own annual college renewal prompted me to review the publicly available financial reports in detail.
What I found surprised me.
Looking at my own College, cash reserves increased by approximately $3 million in the last financial year alone to now exceed $20 million. At the same time, the College recorded an additional operating cash surplus of approximately $4 million, partially offset on the balance sheet by a paper property devaluation.
That raised a larger question: How did my own College compare to the others?
What shocked me more was stepping back and reviewing the cumulative financial position of all 16 AMC-accredited medical colleges across Australia.
Between cash reserves, property portfolios and investments, these institutions collectively appear to control assets exceeding $1 billion.
That is an extraordinary figure for organisations originally established to oversee training, standards and professional representation.
And more importantly, why does the profession feel more politically under-represented than ever?
At precisely the moment governments are openly questioning specialist fees, expanding non-medical scopes of practice and entertaining arguments that “others can do it too”, the collective voice of specialist medicine feels strangely absent from the national conversation.
Pharmacists are lobbying aggressively. Nursing groups are politically organised and highly effective. Allied health groups increasingly speak with coordinated clarity about workforce expansion.
Meanwhile, medicine often feels like a fragmented profession standing quietly on the edge of the chessboard while everybody else is already making moves.
Which is extraordinary when you consider that doctors are, in fact, the people most deeply trained in the complexity of the human body, disease and healthcare systems themselves.
We understand the complexity of the board.
Increasingly, others move a single piece and insist they are the game.
Meanwhile, in a remarkable juxtaposition to this financial growth, the profession itself has never seemed more politically diminished.
Many colleges receive substantial government funding. Many generate millions annually through examinations, training fees, courses, conferences and assessments. Many hold significant property portfolios and investment reserves accumulated over decades.
The question doctors are increasingly asking is simple: Why?
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Why are organisations originally built to represent medical standards and training increasingly operating like large corporate entities focused on perpetual institutional growth?
Why, in an age of mounting attacks on specialist autonomy and growing political pressure around medical costs, does so much institutional energy appear directed inward rather than outward?
Looking again at my own specialty college, Fellows contribute over $10 million annually in subscription fees alone.
The same financial reports also identify approximately $10 million in annual “member services”.
But what exactly are those services?
Executive remuneration packages of approximately $2 million are listed separately. Staff wages and employee benefits – approximately $15 million – are listed separately. Government grants are listed separately. Revenue from training programs, examinations, courses, conferences and assessments is also listed separately, generating many millions more in income.
So, what exactly constitutes the additional $10 million in “member services”? Because it is difficult to believe the answer is CPD administration.
NASOG now has affiliation with AMA CPD Home. Hypothetically, if NASOG were asked to administer compliant CPD for the entire Fellowship cohort in O&G, it could achieve that for under $500,000 annually. All while simultaneously the College would continue to be worth over $60 million.
Which naturally raises another question: Where is the rest going?
Why are public hospital specialists increasingly surrendering their continuing medical education allowances simply to maintain mandatory professional affiliation?
And why is nobody discussing the downstream consequences for patients?
Because these costs do not exist in isolation.
For a specialist in private practice, a College fee exceeding $4300 is not simply a $4300 business expense. Like any small business cost, it must be generated from pre-overhead, pre-tax revenue. Once practice overheads and taxation are considered, many specialists must generate well over $13,000 in patient fee revenue simply to remain affiliated.
That money has to come from somewhere.
Ultimately, it flows into the cost of delivering healthcare.
None of this is an argument against strong colleges.
Medical colleges matter enormously. Training standards matter. Accreditation matters. Patient safety matters.
But somewhere along the way, many colleges appear to have drifted from being custodians of professional standards into becoming large self-sustaining corporate institutions.
And corporatisation changes behaviour.
Boards become increasingly focused on asset growth, risk management, property portfolios, brand protection and organisational expansion. The language of medicine slowly gives way to the language of administration.
Yet healthcare was never meant to function like a bank or a property fund.
The late Paul Ramsay once famously observed:
“If you take care of the doctors and the patients, everything else takes care of itself.”
It is a remarkably simple philosophy.
And perhaps that simplicity is precisely what modern medical institutions have lost.
Because in the end, the real question is not why the colleges became so wealthy. It is why specialists are paying more than ever to organisations that seem increasingly unable – or unwilling – to represent the doctors who are, in fact, the ones overwhelmingly representing the patients of Australia.
Dr Elizabeth Jackson is the president of the National Association of Specialist Obstetricians and Gynaecologists.
