The Australian Orthopaedic Association (AOA) and New Zealand Orthopaedic Association (NZOA) proposal to split from RACS would fundamentally alter the structure of surgical training in Australia and Aotearoa New Zealand, with significant implications for Trainees, Fellows, health systems and the community.
RACS' position is clear. We support stronger specialty leadership, unity, and modernised training through a faculty-based model within RACS, while delivering genuine reform.
RACS is concerned about dismantling the existing system which has provided certainty, consistency, stability and safety for the past century. Our key concerns are set out below.
Members value their FRACS
FRACS is internationally recognised as the gold standard of surgical qualification in Australia and Aotearoa New Zealand. It reflects rigorous training, independent accreditation, demonstrated competence, and a sustained commitment to professional standards. This reputation has been built over the last 99 years through consistent quality assurance and public trust.
AOA and NZOA's attempts to minimise the significance of FRACS, and the brand value attached to it in Australia, Aotearoa New Zealand and internationally, demonstrate a fundamental misreading of how the surgical system functions. We know the community values FRACS. We know our members value FRACS. We know the medical system has benefited from FRACS.
Introducing a new, unproven post-nominal from a newly established organisation lacks this foundation. It risks public confusion, weakens professional recognition, and undermines the collective authority surgeons have built over generations.
A single, unified framework underpins patient safety, Trainee confidence, workforce mobility and international credibility. FRACS is the unifying symbol of trust for patients, employers and regulators, and that is why RACS will continue to offer FRACS to surgeons who train through an accredited RACS pathway.
Serious questions over proposed governance
Serious questions remain about the proposed governance of ANZCOS. As an entity owned and governed by two surgical societies, there is a lack of clarity around leadership, accountability, Fellow recognition, and whether a newly established organisation could match the infrastructure and regulatory safeguards currently provided by RACS.
RACS is accredited by the Australian Medical Council and the Medical Council of New Zealand to oversee surgical training across nine specialties, including orthopaedics. AOA and NZOA have not clearly explained how an ANZCOS pathway would function within health services, jurisdictions, or training sites for the benefit of Trainees, health services and the community.
There are repeated claims that a RACS faculty model would reduce specialty autonomy, while simultaneously stating that AOA and NZOA has not meaningfully engaged with RACS on such a model. Both propositions cannot be true at the same time.
Based on engagement to date, RACS' view is that AOA and NZOA's approach has been largely performative. This raises serious questions about whether the proposal reflects the will of the profession.
Duplication and cost
Under current proposals, training delivery would continue to be outsourced to AOA and NZOA via service agreements, meaning the same operational layers would remain. Establishing ANZCOS would not remove duplication, it would add another organisational entity.
AOA and NZOA have not shared consolidated or independently assured financial modelling with RACS, nor have members been provided with a transparent comparison of costs across all options.
Orthopaedic training is already the most expensive surgical training program in Australia, driven largely by specialty-specific fees set by AOA. Training itself is delivered primarily in hospitals by supervisors and trainers who are members of both RACS and AOA/NZOA, with accreditation providing independent oversight. RACS currently engages AOA to deliver 16 of 41 activities under the service agreement.
The strength of a unified voice
Fragmentation does not increase influence. In a regulatory environment characterised by consolidation and increasing complexity, multiple competing institutional voices weaken professional leverage and favour those who seek to diminish professional autonomy.
A unified surgical college enables consistent national standards, coordinated advocacy, and integrated workforce planning across regions and subspecialties, particularly in areas such as trauma, hand and spinal surgery, road safety, rural surgery, regulatory reform and quality improvement.
RACS also directly supports orthopaedics through education, research and scholarships, and provides inclusive national structures that bring together rural and regional surgeons, Aboriginal, Torres Strait Island and Māori surgeons, and those working in academic, military and medico-legal practice. Shared services, including professional standards, the RACS Library, Foundation scholarships, wellbeing programs and global health, benefit the entire profession.
Cost savings through a proposed faculty model
RACS proposes a modernised faculty-based model within RACS that delivers genuine reform while preserving the benefits of a mature, internationally recognised accreditation framework.
This approach:
- strengthens specialty leadership while maintaining unity
- modernises training while safeguarding quality and patient safety
- improves access, diversity and equitable regional distribution of training posts
- reduces cost and duplication without creating additional organisational layers.
This approach achieves the reforms many orthopaedic surgeons are seeking, without the financial, structural and regulatory risks inherent in establishing a separate college.
Over the past two years, RACS has strengthened governance, restored financial discipline and progressed significant reform through the Surgical Pathways Strategy. This includes a two-year freeze on member fees, a five per cent reduction in the RACS component of training fees in 2026, and reductions in skills course costs, with further reforms underway.
Conclusion
The profession is strongest when it is united. RACS encourages all members to carefully consider the implications of the proposed split and engage with RACS on the faculty-based alternative.
