In March of 2026, the first of seven sessions at an Australasian College for Emergency Medicine (ACEM) workshop in Melbourne was not about emergency medicine. It was about eels.
Specifically: eel-smoking in tree bark, the protein content of witchetty grubs, and the agricultural sophistication of Aboriginal tribes before European settlement. The session was delivered by a business manager. At its conclusion, participants were encouraged to write a reflection on the content and submit it for CPD credit — simultaneously satisfying cultural safety and health inequities competencies in a single administrative stroke. Consider this mine.
I had flown 3,100 kilometres and arrived after midnight. ACEM paid the fare.
This is not a complaint about one session. It is a question about what ACEM thinks it is for — and whether the answer has quietly changed.
In June 2015, four senior Fellows of the Royal Australasian College of Physicians (RACP) published “The scourge of managerialism” in the Medical Journal of Australia. What they saw was real: specialist colleges were swapping collegial self-governance for corporate administration. Clinician committees gave way to executive boards. Professional authority was being displaced by managerial authority. They were right about the diagnosis. They were wrong about where it led.
The authors assumed corporate governance would make specialist colleges timid — institutions so consumed by risk management that they would retreat from contested public questions. Instead, Australasian specialist colleges now have larger advocacy footprints than at any point in their history. ACEM, RACP, and their counterparts issue regular position statements on climate, Indigenous equity, refugee detention, racism, and gender.
Corporate governance replaced professional voice with an institutional one. For a professional, silence can be dignified. For an institution, as the activists helpfully remind us, silence is violence. The eel session did not happen despite ACEM’s governance structure. It happened because of it.
ACEM’s stated mission is to promote excellence in emergency care through expert members — training emergency physicians, maintaining professional standards, credentialing those who meet them. That credentialing function is the institution’s core authority. Use it on the right things and it means something. Use it on the wrong things and it doesn’t.
A patient in an emergency department is frightened, often alone, and can struggle to advocate for themselves. They extend extraordinary trust to a clinician they have never met. That trust is not given to the institution. It is given to the clinician. ACEM’s job is to ensure the clinician has earned it. Eel smoking has nothing to do with that.
Cultural awareness with genuine clinical application belongs in medical formation. The clinicians I spoke with in that Melbourne room knew that. They were baffled anyway. There were muted murmurs at lunch about going out to get some eels. That is not cynicism. That is professionals recognising that something has gone wrong.
When CPD credit tracks moral reflection rather than clinical performance, the credential means less than it says it does — and the college’s formal authority is being used to reward the wrong thing.
The authors of the 2015 MJA article worried about member disengagement. They had it backwards.
ACEM’s mission is stated clearly. The question is whether what happened in that Melbourne room is consistent with it — and whether anyone with standing inside the institution is authorised to say so.