From the Ground Up Building an Indigenous Ophthalmology Workforce

It’s largely thanks to his advocacy that since then, RANZCO and the Australian and New Zealand Eye Foundation (ANZEF) have committed to increasing the number of Aboriginal and Torres Strait Islander ophthalmologists. Consequently, and with support of the Australian Indigenous Doctors’ Association (AIDA), in the past two years, four Indigenous trainees have commenced RANZCO’s vocational training program. It is hoped that their success will attract even more Indigenous doctors into the profession over the coming years.

 the future of increased workforce diversity within RANZCO and the development of a sustainable, robust Indigenous ophthalmic workforce bodes well for the future

In this article Assoc Prof Rallah-Baker and ophthalmology trainee Dr Thomas Mylne share their experiences. Additionally, Paula Llavallol from ANZEF and Lili Chen from AIDA speak about the programs now in place to support trainees.

Creating a Pathway to the Future

Associate Professor Kristopher Rallah-Baker

Since my admission to RANZCO as a Fellow in 2018, we have seen RANZCO make positive moves to a binational, merit-based selection system, which acknowledges the importance of recruiting, supporting, and growing the Aboriginal and Torres Strait Islander ophthalmic workforce in Australia as well as the Māori and Pasifika workforce in New Zealand. To reach population parity of Indigenous ophthalmologists in Australia, we need around 40 Aboriginal and Torres Strait Islander Fellows; we are currently 1/40th of the way there.

The path to recruitment of under recognized and generally underprivileged populations into a College such as RANZCO is challenging; the reasons are historical. There are long held beliefs, whether true or not, regarding the stigma of selection onto the Vocational Training Program (VTP). It is often perceived to be impossible, and there are rumours of unrelenting challenges during training.

Despite this, recruitment outcomes for Aboriginal and Torres Strait Islander trainees to date have been positive: we currently have one Aboriginal trainee and one Torres Strait Islander trainee in second year, one Aboriginal trainee in first year, and an Aboriginal trainee – Dr Thomas Mylne – was recently accepted onto the VTP for 2024 (making a total of four trainees across three training years in 2024).

With this success in such a short period since my graduation, the future of increased workforce diversity within RANZCO and the development of a sustainable, robust Indigenous ophthalmic workforce bodes well for the future.

We must however, not only recruit, but graduate those we take onto the VTP. If they are good enough to complete medical school and commence training, they are good enough to eventually graduate as RANZCO Fellows and must be appropriately supported through that process, with an understanding of the added complexities and challenges that inherently exist within most Indigenous Australians’ lives.

A Collaborative Effort

The successful recruitment outcomes described here have not been without the hard work and genuine collaborative efforts of non-Indigenous ophthalmologists, RANZCO, the Fred Hollows Foundation, AIDA, and ANZEF.

As the first Australian Indigenous ophthalmologist, it has been a real privilege to work alongside and within these organisations to assist with bridging and creating the understanding and pathways necessary to establish what I foresee as the achievement of population parity of Indigenous ophthalmologists in the coming years.

We will have a lot to be proud of once that goal is reached, and our College will be richer for the experience. I will be personally very proud of the role I have played in that process.

The Future is Here

Indigenous eye health is all of our responsibility and although the rates of blindness have reduced from 10 times to three times that of the non-Indigenous rates in Australia, we still have a lot of work to do.

Indigenous ophthalmologists will play a large role in negotiating the final pathway to ‘closing the gap’ in eye health and then maintaining that position, in collaboration with our non-Indigenous colleagues. There will be unforeseen positive consequences of embedding ancient Indigenous knowledge and ways into ophthalmic practice, just as we have seen in mainstream healthcare.

The future is here, we have embraced it and we have an exciting future to look forward to as a College and workforce serving all Australians.

Embarking on the Path

Dr Thomas Mylne

I was asked to write this piece by my mentor Assoc Prof Rallah-Baker. The instructions were around 500 words on being a RANZCO applicant/pending trainee.

While the task seemed simple, it did take me time to collect myself and actually think about what I could say that captured where I’m at and how I’m feeling at this point in time.

The few weeks leading up to being accepted as a trainee for 2024 were an absolute whirlwind. Finding out I was fortunate enough to be selected, then thinking through how I would need to rearrange my life, came with a mix of disbelief, excitement, humility, and gratitude.

An Atypical Start

To date, my career path has been consistently atypical, dynamic, and adaptive. Growing up in Gladstone in Central Queensland I knew from a young age I wanted to be a doctor. I had a grandmother and aunty who were both nurses and my pop was a paramedic, but we had never had a doctor in the family. I had loving, supportive parents who encouraged me every step of the way.

Fast-forward to university and I started out in undergraduate science, but after 12 months changed to pharmacy as I desired a more patient-centric focus in my studies.

I completed my degree then decided to join the Royal Australian Air Force. I worked as a Pharmacy Officer for five years across Australia before finally biting the bullet and heading back to university as a ‘mature age’ student, commencing medicine at 27. I decided to do the combined Doctor of Medicine/Master of Public Health at the University of Melbourne, with my clinical years spent at the Royal Melbourne Hospital.

During my studies, COVID came to visit and thanks to lockdowns I found myself stuck in new states three times, resetting up my life each time, and getting on with my studies. I completed six months of my Master of Public Health online while living at home with my parents in Gladstone. I completed six months of my research for medicine in Darwin at Menzies School of Health Research, with my final six months of medicine completed at the Wesley Hospital in Brisbane, having found myself stuck for the final time in a lockdown after coming home to support my family when my father became unwell.

Looking For the Best

I always looked for the best in every situation, and the Royal Brisbane and Women’s Hospital was one of those bests for me. I was fortunate to secure internship there and commence my medical career.

I had always had a keen interest in ophthalmology, and through medical school attended RANZCO congresses, and was grateful to be supported by RANZCO to attend AIDA conferences. As a proud Gangalu man, I could see the amazing work being done for First Nations people in this field, and this was a key incentive behind my interest.

But the defining moment came postgraduation. Throughout medical school I had continued to work as a pharmacist on evenings and weekends to help fund my studies, and as a graduation present to myself I used my savings to pay for my own laser corrective surgery.

With that surgery, my life changed. Suddenly, I did not have to wear contacts every time I went to the gym. I could go for a surf and see the next set rolling in in time to catch it. And I could wear a face mask without fogging up my glasses, no matter what I did to fix it.

It might sound trivial, but what I experienced was a change in my quality of life, and I realised how good that felt. From then, I was driven to share this experience with others through my chosen career.

I was fortunate to gain further experience in ophthalmology during my junior years at the Royal Brisbane and Women’s Hospital, which reaffirmed my decision to pursue this career. Not only was I clinically engaged, but I was excited and impressed by the calibre of my colleagues that I got to work with every day. The team that made up the ophthalmology department, inclusive of doctors, nurses, administration, and allied health, made coming to work something to look forward to.

I am incredibly grateful for the ongoing support I have received through RANZCO, AIDA, and ANZEF in my prevocational years. I want to pay a special mention to the amazing work of Lili Chen, the AIDA Eye Health Project Officer who has gone above and beyond in helping me along my journey.

I am incredibly excited to commence training in 2024, incredibly grateful for this opportunity, and incredibly humbled by the amazing people I call my colleagues.

we need around 40 Aboriginal and Torres Strait Islander Fellows; we are currently 1/40th of the way there

Identifying Opportunities

Lili Chen

AIDA is the national peak body representing Aboriginal and Torres Strait Islander doctors and medical students, focussed on equitable health and life outcomes for Indigenous people. The organisation does this by working towards reaching population parity of Indigenous medical students and doctors, and supporting a culturally safe healthcare system.

AIDA’s Specialist Trainee Support Program (STSP) was established to strengthen the recruitment and retention of Aboriginal and Torres Strait Islander non-GP trainees. The overall aim of the program is to increase the Indigenous non-GP workforce.

The Fred Hollows Project is an initiative funded by The Fred Hollows Foundation and implemented within the organizational structures of AIDA’s STSP. By supporting the employment of a Project Officer within AIDA, this project aims to increase the number of Aboriginal and Torres Strait Islander ophthalmologists and ensure cultural safety is embedded throughout the ophthalmology specialisation pathway. This role engages individually with members, students and doctors interested in, or intending to pursue the specialty of ophthalmology, and current trainees in ophthalmology.

The Project Officer uses and builds upon their understanding of the requirements in ophthalmology training, such as research and practical ophthalmic experience. In this way, AIDA members have access to support in their preparation, application, selection, and, ultimately, training in ophthalmology.

Wrap-Around Support

Key enablers of success and retention for Aboriginal and Torres Strait doctors include flexibility in training, which acknowledges the various family, cultural, and community responsibilities often shouldered by Aboriginal and Torres Strait Islander doctors. Additionally, connection to community and Country within mainstream training and education structures, networking opportunities, culturally appropriate support, and financial support must be available prior to and during training. The Fred Hollows Project continues to develop and provide this wrap-around support to our members in ophthalmology.

Furthermore, the Fred Hollows Project initiates high-level engagement with key stakeholders in ophthalmology training and the broader eye sector. Advocating for developing best practice strategies in the selection, recruitment, and retention of Aboriginal and Torres Strait Islander ophthalmologists ensures we are building towards an eye care system that is culturally safe for our trainees and responsive to the needs of Australia’s populations.

It is hoped that the unique strengths, skills, and medico-cultural expertise and experiences of our Aboriginal and Torres Strait Islander doctors continue to not only be acknowledged but celebrated.

When the Australian healthcare system reaches and serves its most vulnerable populations through culturally safe and inclusive services, we can then strive to make progress in ‘closing the gap’ in health outcomes across the country.

Working Towards Equity

Paula Llavallol

RANZCO is committed to activities that seek to achieve equity in access and health outcomes for Aboriginal and Torres Strait Islander peoples. Understanding that health outcomes are closely connected to self-determination, RANZCO recognises that the effort to increase the number of Indigenous ophthalmologists will play a significant role in tackling the persistent disparities in eye health that affect Aboriginal and Torres Strait Islander peoples.

To support its commitment to increasing the number of Aboriginal and Torres Strait Islander ophthalmologists, RANZCO has developed a comprehensive strategy in collaboration with its philanthropic arm, ANZEF.

The key components of the strategy are outlined below.

Generating Interest

Despite the importance of vision care to health and wellbeing, medical students typically receive little exposure to ophthalmology during their studies. In response to this, ANZEF is partnering with the AIDA and university medical schools to empower Indigenous medical students and doctors to engage with RANZCO Fellows and explore the pathways to specialisation.

Opportunities for participation include funding for ophthalmic research projects and electives, grants to attend key medical conferences like the annual RANZCO Congress, and the National Aboriginal and Torres Strait Islander Eye Health Conference, and offering valuable insights and networking opportunities. At the AIDA conference, RANZCO’s Eye School session invites participants to experiment with ophthalmic tools, discuss training requirements, and find out about what it’s like to work as an ophthalmologist.

Trainee Selection and Support

The RANZCO selection process positively discriminates by scoring eight points (out of 100) for Aboriginal and/or Torres Strait Islander applicants and guaranteeing an interview for all Aboriginal and Torres Strait Islander applicants who satisfy the entry criteria.

Additionally, the College prioritises the health, welfare, and interests of trainees and their right to a safe and supportive professional learning environment; ensuring a robust support structure to assist those who encounter difficulty at any stage of the training pathway.

Scholarships and Grants

Recognising that the financial costs are a major barrier to completing speciality training, the goal of ANZEF Scholarships is to attract Indigenous doctors to the RANZCO ophthalmology VTP, and support these trainees during their journey to specialisation.

The ANZEF Aboriginal and Torres Strait Islander VTP Scholarship awards successful trainees a AU$30,000 scholarship towards the cost of their training fees for the five-year VTP.

ANZEF also supports Indigenous doctors and medical students with a one-off reimbursement of the RANZCO selection application fee ($1,800); and grants to attend ophthalmology and medical conferences. Additionally, the Yarranabbe-ANZEF Indigenous Award in Ophthalmology at the University of New South Wales (UNSW) provides $10,000 each for two recipients per year to complete a research project in ophthalmology during their fourth year of medicine.

These initiatives were inspired by Assoc Prof Rallah-Baker and his advocacy on the profound significance of population parity for Indigenous ophthalmologists. His stated goal of getting from only one Indigenous ophthalmologist to 40 has resonated deeply with RANZCO’s members, and has spurred the Foundation to focus its efforts on achieving this.

These efforts have been made possible through the generosity of philanthropic donors including the Finemore Family, ANZEF Patron Mrs Roslyn Packer AC, the Yarranabbe Foundation, and Foundation Establishment partners, Novartis, and Bayer Australia.

Associate Professor Kristopher Rallah-Baker BMed, FRANZCO is Australia’s first and currently only Indigenous ophthalmologist. A proud Yuggera, Warangoo, and Wiradjuri man, Assoc Prof Rallah-Baker is a founding member of the Australian Indigenous Doctors’ Association, a Director on the Federal Board of the Royal Flying Doctors Service, a Zeiss key opinion leader for cataract and comprehensive ophthalmology, Director on the Board of the Nova Peris Foundation, Foundation Director of the First Nations Eye Health Alliance, and Chair of the Vision2020 Indigenous Committee.
Dr Thomas Mylne is a Junior Medical Officer, Ophthalmology, at the Royal Brisbane and Women’s Hospital and a 2024 ophthalmology trainee at the Royal Victorian Eye and Ear Hospital.
Paula Llavallol is the Head of Foundation at the Australian and New Zealand Eye Foundation.
Lili Chen is the Project Officer, Eye Health at the Australian Indigenous Doctors’ Association.