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Last September, The Specialist ran an opinion piece by Dr Rob Burrell and Dr Marty Minehan titled “Will we go back to our love affair with jet travel?” which asked some tough questions about the future of CME travel in the age of climate awareness. Respiratory medicine specialists at Auckland District Health Board took issue with aspects of the article. Their letter, along with a response from Dr Burrell and Dr Minehan, is published below.

We write collectively to express our disappointment at the ASMS support of some of the opinions expressed in the article “Will we go back to our love affair with jet travel?” Our diverse respiratory department in a tertiary centre has national and international experts in a number of sub-specialty areas. We have developed that expertise over the years through fellowships, sabbaticals and invitations to international working parties and advisory groups. We have also worked hard to recruit young and talented SMOs who we hope will carry our services forward into the future. The senior members have built up connections over years of networking to create training pathways for the registrars we have recruited to join our service. None of this would have been possible had we been unable to travel overseas supported by MECA CME entitlements. We believe the people of Aotearoa New Zealand deserve and expect a high quality of specialised health care. As specialists in our fields, we receive frequent referrals and calls for advice from our colleagues around the country, and are able to call on our overseas friends and colleagues to provide support with some of our more challenging cases. The last year has provided challenges in terms of fostering and maintaining such networks, communication with all non-local colleagues, and ensuring ongoing education and CME. We have all also felt the stress of the repeated lockdowns, lack of leave, and time away from the workplace. Those SMOs privileged enough to be towards the end of their careers, and having already enjoyed all the benefits of travel and networking, may be happy to and be well placed to undertake CME at home. They may underestimate the challenges faced by their younger colleagues living in shared accommodation, with multigenerational families or with children at home, attempting to undertake CME by Zoom either at home or by default in the workplace. Our department supports endeavours to reduce carbon emissions both at a personal and group level. We believe, however, that well-chosen and justified CME-funded travel provides a vital role in ensuring that the people of Aotearoa New Zealand get the highly educated and specialised medical workforce that they deserve and increasingly demand. Senior SMOs who have enjoyed all of the benefits of CME travel or who work in less specialised areas where the benefits are less apparent should not deprive our young specialists trying to build careers (often in conjunction with raising families) of the opportunity to educate themselves to the same high level and to build up the same international networks that we did to allow advancement of our careers. Respiratory medicine specialists, Auckland District Health Board

The Response: Thank you for engaging in the debate. We are very pleased that SMOs have given our article some attention. It was certainly intended to get people thinking about their contribution to climate change. We cannot but agree with you. Overseas travel and our CME entitlements have created an environment where SMOs have flourished, knowledge was gained, and skills were honed. The contacts we made with our overseas colleagues benefited our careers, and our patients. Two decades or more of available and refundable travel within the ASMS MECA has been great for us all. Those two decades have not been kind to the planet, however. The only certain thing is that the future will not look like the past. We would like to see senior doctors leading this issue, not reacting to interrogation by media, nor fighting resentment and obstruction by management. The public expects doctors to provide direction, not just health care. Publicly funded business class air travel is rapidly becoming a bad look, and there will be significant changes in the travel policies of DHBs. In December, the Government (perhaps optimistically) committed Aotearoa’s public sector to carbon neutrality by 2025. What will that look like? If doctors are not coming on this journey, what hope is there for us, the public, or even the planet? We disagree with the implication that this is a generational issue. In fact, younger doctors have probably travelled more at their stage of training than older doctors. Commercial air travel has shown an exponential rise since the 1950s, and doctors have been keen to purchase tickets. Younger doctors have the most to lose from unbridled carbon emissions, and will have to live with the consequences of climate change, while many older doctors will be gone before things become very uncomfortable. However, pitting generation against generation is not constructive in this debate and will not bring about the required changes in our carbon emissions. We are not advocating a moratorium on CME air travel. We know that doctors will continue to want to travel to learn, teach, and connect. But we are suggesting that we will all have to be much more judicious in the where, why, and how. Constraint will come, before 2025, whether we like it or not. Better to create these checks than have them imposed on us. The opinions expressed in the article are our own. They are not mainstream ASMS thinking, as far as we know. We ask our colleagues to imagine a future where we have faced the realities of unrestrained carbon pollution. What does good medicine look like in that scenario? It is an uncomfortable question; it exposes a conflict between wants and needs. Dr Rob Burrell, Dr Marty Minehan