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On a quiet Wednesday morning, on the 27th floor of a sleek building overlooking Sydney Harbour, a group of doctors from one of Australia’s oldest medical colleges were preparing to vote in an extraordinary general meeting.

The meeting’s agenda was an unusual one but, even so, no one expected the police to show up.

But their arrival signalled a climax to an issue that has plagued the Royal Australasian College of Physicians for months.

In one room was Prof Jennifer Martin, the president and board chair. The college’s members were being asked to vote on whether to remove her from her position five weeks early.

In another room, on her laptop, sat Dr Sharmila Chandran, who was voted president-elect in 2024 and was due to take over Martin’s role next month, and whose husband had called the police.

The pair had long disagreed on the former’s push for constitutional reform, to separate the roles of president and board chair in line with other medical colleges.

The board – whose directors work in a voluntary capacity – has been beset by months of conflict. The infighting has been lambasted as “a royal mess”, an “absolute shitshow”, and “a trainwreck in slow motion” by frustrated physicians across the country, culminating in last week’s public dispute and requests for intervention by the national charities regulator. It highlights deep fractures in a wealthy and historically powerful organisation riven by longstanding dysfunction, which is underscored by wider cultural problems within medicine.

The RACP comprises more than 32,000 physicians in Australia and New Zealand across 33 specialties, including cardiologists, gastroenterologists, haematologists and neurologists. To become accredited as a specialist in any of these fields, trainee doctors have no choice but to pay thousands of dollars each year in membership fees.

Last week’s vote to remove Martin as president was requisitioned by at least 100 RACP members, who cited board instability, and poor oversight of expenditure among reasons they had “lost confidence in the leadership of Martin”.

Each board chair is elected by RACP members to serve a two-year tenure first as president-elect, then a further two years as president. Martin became RACP president in 2024 and was due to finish in the role in May.

‘Our college now has two competing boards’

Conflicting accounts paint a spectacular picture of last Wednesday’s chaotic gathering, which began with a disagreement over who would run the meeting.

Martin, as president, sought to chair it, according to a statement sent to college members on Wednesday afternoon from the board – which at that point consisted of Martin, Chandran and two others. The statement claimed Chandran allegedly “spoke over the chair and did not stop”.

She “continued the meeting in a location in a closed room with the chair, the CEO, other directors and the interim company secretary excluded”, the board alleged.

Chandran issued her own statement hours later, saying: “Given that the motion concerned the removal of the president, it was not appropriate for the president, Jennifer Martin, to chair the meeting because of her conflict of interest.”

She says she was rehearsing for the meeting when she felt intimidated by others’ behaviour, telling Guardian Australia her husband called the police as a result.

NSW police said officers had been sent in response to “reports of a person attending the meeting … Police spoke with several people and it was determined no crime had been committed.”

Officers remained in attendance when the EGM began at noon. Chandran says she moved to a separate room to conduct the meeting from her laptop, and that her husband “had to stand at the door”.

Only 4,260 RACP members voted, with a majority of those (2,179) in favour of ousting Martin.

“The results were not correctly scrutineered, and the board believes the vote is invalid,” it said last Wednesday. The board’s view was that “Martin remains the chair”.

Chandran, in her own email, said the board’s statement “was not authorised by me (chair of RACP) and does not represent the official position of the RACP”.

By Wednesday evening, Martin had been removed as a director in documents lodged with the Australian Charities and Not-for-profits Commission (ACNC) and the Australian Securities and Investments Commission. A day later, three new directors were added to the board, according to documents lodged with the ACNC and Asic.

“It is a legally constitutional board so we can and we will move forward,” Chandran says.

But another email from “the RACP board”, sent from an official college address last Thursday evening, said there had been “no change to the composition of the RACP board”, which it said still consisted of four people, including Martin.

Five days later, on Tuesday, the other two board members – Dr Nick Buckmaster and Dr Janak de Zoysa – issued a statement to RACP members describing a “constitutional crisis”. “Our college now has two competing boards,” they wrote.

They said the charities watchdog had sought a meeting with the RACP “due to significant concerns”. “We again request that the ACNC suspend the board and appoint acting responsible entities to permit to the college to determine, free of interference, the legality of the recent EGM.”

The Australian Medical Council, which accredits specialist medical colleges, has also expressed concerns. In a statement to Guardian Australia on Wednesday, it said: “The AMC’s accreditation standards include requirements for good governance. The AMC is concerned that the RACP may not be meeting these standards and is engaging with the college to seek urgent answers to the current issues.”

‘Doctors live in a world of constant competition’

Doctors have been blasted with dozens of emails from the RACP. “We’re bombarded with endless emails documenting these catfights – it’s embarrassing, it’s absurd,” says a paediatric trainee in Victoria who did not want to be named. “How is this the most important thing that they have to do given the current state of the healthcare system?”

Last August the board informed RACP members that it had passed a vote of no confidence in Chandran. Guardian Australia understands that six of the board’s 10 directors resigned over the no-confidence motion and how it was communicated to members.

The board communique accused Chandran of engaging “in adversarial and disrespectful behaviour” and contributing “to a toxic culture at the board table”.

On 21 September, Chandran wrote to members “reject[ing] these damaging claims completely”.

“I have repeatedly raised concerns about bullying and harassment in the college,” she wrote, revealing that she had lodged an application for an anti-bullying order with the Fair Work Commission last May.

Chandran has since dropped the case, citing frustration with delays in the tribunal’s process. “I don’t think Fair Work is very fair … it’s not serving the Australian community,” she says.

In March the RACP was found to be in breach of workplace health and safety laws, receiving a SafeWork NSW notice stating it did not “adequately manage the risk of harmful behaviour … within the operations of the board”. A request in the same month for the ACNC to dissolve the board was unsuccessful.

The RACP turmoil is a reflection of a “culture of doctors that’s hidden from the public”, says one physician who does not want to be named.

“Doctors live in a world of constant competition,” she says. “That power struggle, that attitude of ‘I will destroy you before you destroy me’ … You can’t have a conflict between two people eat up in an entire organisation or a profession like this, unless this was truly part of its culture.”

Last Wednesday’s vote to oust Martin was the fifth EGM in six months. Two of the previous four meetings were attempts to remove Chandran as president-elect and board director, resolutions which were overwhelmingly voted down by members.

At these meetings, Chandran says, “I was professional, I was respectful. I came, listened to the vote, accepted the vote, and walked out.”

After reading about Wednesday’s gathering, Prof Ron Grunstein at the Woolcock Institute of Medical Research in Sydney, joked that “perhaps the late Jerry Springer should have chaired the meeting”.

Grunstein, who has been an RACP member since 1987, says the infighting distracts from the main role of the college, which he sees as “to train the next generation of physicians, maintain standards and try and make sure we’re represented with government”.

“People are just disenchanted, and given an opportunity to vote with their feet and leave, I wouldn’t be surprised if they do.”

Since October 2024, federal legislation changes have meant specialists recognised as fellows no longer need to be members of a medical college to practise – and can fulfil their continuing professional development requirements via other means.

For Dr Luke Gaffney, a general physician in Queensland, the “absolute shitshow” of RACP infighting prompted him to leave. “It was this endless stream of extraordinary general meetings that were being called, and the realisation that I had no interest in it.”

“It’s so childish, it’s so unprofessional,” he says. “The irony is that they don’t even know that I haven’t paid my annual renewal fees, and they continue to send me emails every week.”

‘A self-aggrandising delusion’

The five EGMs in the last six months – three of which were held on 31 October – were estimated by the RACP board to have cost at least $640,000 in total.

“We continue to pay money for this accreditation in a college that seems to be just wasting the funds on these EGMs and arguments,” says an advanced trainee who estimates she has spent at least $20,000 in membership fees.

Junior doctors must complete three years of basic training and three to four years of advanced training before they qualify as a specialist physician. Annual membership for trainees amounts to $4,000 a year. They also pay the college to sit their mandatory exams.

“In an exam year, I easily spent $10,000 in college fees,” another physician says. “I’ve had friends commit suicide. I’ve moved 10 times during the course of just my advanced training.”

Gaffney says: “The terrible thing is that the trainees have no choice. They are bonded to this dysfunctional college in order to get the outcome that they desire for their career. It’s just an insoluble mess.”

Dr Jolie Lawrence, a paediatrician, says: “A lot of the reason people feel hesitant about leaving the college is because it leaves trainees in the lurch. You have to be a fellow of the RACP to supervise trainees.”

The RACP is a registered charity that generated $87.3m in revenue in 2024 – $73.8m from membership fees and examination costs. It had more than 400 full-time employees, and logged $87.4m in expenses, including $55.8m in employee expenses and $8.8m in professional and consulting fees.

“The [trainee] supervisors work for free. The examiners work for free. The people who set the curriculum and [on] committees work for free. So what do these 400 people do?” one RACP member asks. She describes the college as “quite obsolete now”.

“There’s a self-aggrandising delusion that has taken hold of this college for many, many years. I think the government has to say: actually, we don’t need you.”

The RACP has been beset by reports of dysfunction for years. In 2018 a catastrophic technical glitch during an exam left hundreds of trainee doctors distressed and forced to resit at a later date. In 2019 the RACP was put on notice by the charities watchdog over multiple concerns including inappropriate management of charitable funds.

“Physicians have been fed up with … hungry power struggle nonsense for the better part of a decade,” a Victorian fellow says. “It’s a royal mess.

“We need fewer committees, we need less professional staff, we do not need to have an office overlooking Sydney Harbour,” he says.

Another agrees: “We’ve been watching this trainwreck in slow motion for a long time now.”

Questions are now being asked about president-elect nominees for the 2026 election, for which online voting closed on Tuesday. No candidates are women.

Among the nominees are Prof Nikolai Petrovsky, who has previously been criticised for advocating for his own Covid-19 vaccine to be approved for use in Australia without making publicly available substantial peer-reviewed clinical evidence to support its efficacy. He has previously said claims Covax-19’s efficacy were unsubstantiated was “an outrageous claim”.

Another candidate is Dr Phillip Morris, whose nomination lists Chandran as proposer, was in 2022 part of a group that advocated “for the medically supervised use of ivermectin-based combinations for the prophylaxis and treatment of Covid-19” – after gold-standard research had found that the antiparasitic drug did not lower the incidence of Covid-19 hospital admissions.

The RACP declined to respond to detailed questions from Guardian Australia.

• In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org