October 2007

Avocation

- a calling or occupation

- a hobby or pastime

A common theme can be discerned in recent changes to the intensive care scene. These developments include:

• Sadly, the death of Don Harrison after a most productive career. Don, aged 75, was still working to improve patient care as a teacher in the simulation centre now named after him.

• The appointment of Rinaldo Bellomo as Editor-In-Chief of Critical Care and Resuscitation. Tub Worthley spawned and grew the Journal and Vernon van Heerden has taken it on to indexation and professional production. Rinaldo’s appointment moves the JFICM Journal into the next phase of development as a high impact journal in the world of intensive care medicine.

• The presentation of 61 candidates at the latest Fellowship Examination and passing of 40. It was an exhausting process for all involved. The resources of two major Perth hospitals and 33 examiners were needed to complete the task very successfully.

• The latest NHMRC Grant round results. Members of the intensive care community were very successful. The total grants to the group approached $5M.

• ANZCA Foundation Grant results. Fellows were also successful in this round receiving approximately 30% of the grants.

• The notice of retirement of several key board members. This will lead to a Board Election and search for the next generation of fellows interested in Joint Faculty affairs, training, assessment and continuing education.

• The shifting of some assessments into training time and the associated increase in work for Supervisors of Training.

• The commencement of planning for several mega units in Australia with greater than 50 beds and needing perhaps more than 20 specialists with diverse non-clinical portfolios.
  

The theme revolves around the commitment of intensivists as volunteers to specialty affairs. I don’t believe that we should try to dissect or excessively analyse why highly talented and hardworking doctors give of their time unpaid. Whether the desire to volunteer is driven by altruism, sense of debt or sense of duty to the specialty, desire for personal growth, continuing education or professional development or the enjoyment of the social mix, it appears to be driven internally. Often called intrinsic motivation by psychologists. Whatever the impetus, it is clear that the specialty is dependent on and indebted to these workers.

The question arises as to how we sustain this effort into the future.

It has been suggested that we should pay volunteers for their time but simple maths would suggest that it would be impossible. A straightforward addition, even neglecting travel and preparation time, shows that in a year the time worked by JFICM Board members and examiners would total more than 4200 hours. For ANZICS it would also mean funding hours of diverse work provided by Board members, database committees, PRICE Committee, Foundation executive and members of the CTG. Paid at even minimum rates this would financially cripple organisations such as ours.

The literature also suggests that providing external motivation, such as financial incentives or rewards, minimalises or trivialises the work, removes or distracts from the true incentives and discourages continuing the effort. Researchers identify the effect and liken it to that of attempting to pay your friends for dinner at their house.

It has also been suggested that future generations will be less inclined to volunteer. I do not believe this is true. Members of generation X will be our next leaders. They have grown up in a unique environment of technological innovation. Members are often characterised as individualistic or even, in Wikepedia, as “apathetic, cynical, disaffected, streetwise loners and slackers [sic]”. These simplifications have no inherent truths and in no way suggest that the desire to help has been bred out of doctors belonging to generation X. In fact the belief that generations are divided by values and attitudes is not supported by evidence, which actually suggests the differences are due more to varying life stages. 

As one of the fathers of modern economics, Adam Smith, wrote in 1759  “How selfish soever man may be supposed, there are evidently some principles in his nature, which interest him in the fortunes of others, and render their happiness necessary to him, though he derives nothing from it, except the pleasure of seeing it.” He must have been observing a Supervisor of Training with trainees.

Nonetheless, JFICM will need an understanding of the particular intrinsic motivation and areas of interest of future generations to harness their skills. It will require facilitation more than external motivation.  JFICM will assess ways, as well as reimbursing costs, to help make it possible for the next group of fellows to continue to give a part of their busy lives, without unreasonable sacrifice, by:

• Valuing non-patient contact work in regulations and documents
• Stressing to hospitals the provision of non-clinical time during accreditation inspections
• Providing backfill salaries to hospitals to cover office bearers with busy portfolios
• Employing professional officers to support more roles.

We do not know that we will be successful but we do know that JFICM is and will be dependent on volunteers for the support of the systems, which maintain the structure of our specialty (accredited hospitals, training schemes, research, examinations, courses, CME, conferences) and justify our processes to bodies such as the ACCC, AMC and the jurisdictions.

R.P. Lee
Dean