2018/19 annual summary

Download the profession-specific data tables for 2018/19 (XLS)

Snapshot of the profession

• 118,996 medical practitioners
• Up 3.4% from 2017/18
• 16.0% of all registered health practitioners
• 0.4% identified as Aboriginal and/or Torres Strait Islander
• 43.4% female; 56.6% male, 0.003% intersex or indeterminate

Age

Specialties

Audit outcomes

Regulating the profession

• 5,359 notifications lodged with AHPRA¹
  • 10 notifications were made about students
• Australia-wide, including Health Professional Councils Authority (HPCA) in NSW and Office of the Health Ombudsman (OHO) in Queensland data, 6,970 registered medical practitioners – or 5.9% – had notifications made about them
• 4,801 notifications closed
  • 5.8% had conditions imposed on registration or an undertaking accepted
  • 3.6% received a caution or reprimand
  • 0.5% registration suspended or cancelled
  • 0.1% fined
  • 16.1% referred to another body or retained by a health complaints entity (HCE)
  • 73.8% no further action taken
• Immediate action taken 170 times
• 339 mandatory notifications received
  • 234 about professional standards
• 895 medical practitioners monitored for health, performance and/or conduct during the year
• 1,043 cases were being monitored at 30 June
  • 104 on the grounds of conduct
  • 182 for health reasons
  • 207 for performance
  • 77 prohibited practitioner/student
  • 473 for suitability/eligibility for registration
• 160 criminal offence complaints were made and 143 closed
  • 83 new matters related to title protection
  • 3 to directing or inciting unprofessional conduct or professional misconduct
  • 68 to advertising breaches
  • 6 to other offences
• Matters decided by a tribunal: 55
• Matters decided by a panel: 22
• Decisions appealed: 30

¹Unless stated otherwise, all notification data is AHPRA data.

A report on the year from the Chair

Medical training survey

During 2019, the Medical Board of Australia invested in the development of the medical training survey (MTS), which will run during the 2019/20 medical registration renewal period.

The MTS has been designed to better understand and improve the quality of medical education in Australia. It will gather feedback from doctors in training in Australia to:

• better understand the quality of medical training in Australia
• identify how to improve medical training in Australia, and
• recognise and deal with potential issues in medical training that could impact on patient safety, including environment and culture, unacceptable behaviours and poor supervision.

It has been a team effort to develop the MTS, the survey questions and the policies that support it. Doctors in training have been involved, along with specialist colleges, employers, educators, the Australian Medical Association (AMA) and the Australian Medical Council (AMC), working closely with health practitioner regulators. The Board established an MTS Steering Committee and MTS Advisory Group, which have supported and advised on the project. These groups include representatives from:

• doctors in training from both the AMA Council of Doctors in Training and the Australasian Junior Medical Officers’ Committee
• specialist colleges
• Directors of Clinical Training
• jurisdictions
• Australian Medical Council
• Australian Medical Association
• Australian Indigenous Doctors' Association
• Medical Deans Australia and New Zealand
• medical students
• employers
• postgraduate medical education councils
• doctors’ health services, and
• consumers.

After a competitive procurement process, EY Sweeney was appointed to administer the survey and analyse and publish the results.

Professional Performance Framework

The Board’s Professional Performance Framework is a long-term project that, when implemented, will help ensure all registered medical practitioners in Australia practise competently and ethically.

The framework is integrated, builds on existing initiatives and is evidence-based. It has five pillars:

1. strengthened continuing professional development (CPD) requirements
2. active assurance of safe practice
3. strengthened assessment and management of practitioners with multiple substantiated complaints
4. guidance to support practitioners – regularly updated professional standards that support good medical practice, and
5. collaborations to foster a culture of medicine that is focused on patient safety, based on respect and encourages doctors to take care of their own health and wellbeing.

During 2018/19, the Board established a CPD Advisory Group to provide advice on what constitutes ‘strengthened CPD' requirements. The Advisory Group proposed a revised CPD registration standard and fleshed out the concept of ‘CPD homes’. The Board will consult on a revised draft registration standard in the next year.

The Board also established a Clinical Advice Committee to progress work on the active assurance of safe practice, and what should be involved in pragmatic and effective health checks for doctors aged 70 years and older. The committee will report to the Board in 2019/20 and the Board will then consult widely about what is proposed.

Improvements in managing notifications

The vast majority (73.8%) of notifications end up with a decision to take ‘no further action’. Despite this, most medical practitioners find it very stressful to be the subject of a notification. Many notifiers also find the process difficult and are often dissatisfied with the results. We know this anecdotally and from our research with people involved in the notifications process.

During 2018/19, the Board continued to work with AHPRA to introduce a range of measures to improve the management of notifications. Areas of priority included reducing the time involved, closing matters early if they did not pose a risk to the public and concentrating resources on high-risk matters. Measures include:

• establishing a Notifications Committee: Assessment, made up of Board members who consider all notifications within days of submission
• supporting the establishment of ‘fast-track’ teams of AHPRA staff who investigate matters that only need a small amount of additional information
• being more agile in the way we consider notifications and, to avoid unnecessary delays, distributing them for handling across our network of state and territory AHPRA offices and Boards
• supporting the development of a range of tools, such as videos, to provide better information for notifiers and practitioners
• ongoing support from Clinical Advisers who are medically qualified AHPRA staff who consider all notifications early and provide advice and support to other staff, and
• ongoing support for the Sexual Boundaries Notifications Committee, which is made up of community and practitioner members with training in sexual boundary violations and related issues. The committee considers all notifications that include any allegation of a sexual boundary violation.

Guideline development and reviews

Pillar 4 of the Professional Performance Framework – guidance to support practitioners – is an important part of the way the Board supports medical practitioners in Australia to practise competently and ethically. During the year, the Board developed or reviewed some guidelines for the profession, all of which were subject to wide-ranging consultation. The Board considers all feedback before finalising these documents.

It has been interesting to see how social media and other forms of digital communication have increased the number of people motivated to get involved in regulatory discussion and made it easier for people to share their opinions.

Sexual boundaries in the doctor–patient relationship

The Board approved revised guidelines on sexual boundaries in the doctor-patient relationship that came into effect in December 2018. The guidelines are accessible on the Sexual boundaries guidelines page.

Guideline for Informing a National Board about where you practice

All National Boards approved the guideline Informing a National Board about where you practice, to help registered practitioners ensure that they meet their legal obligations. The guideline came into effect on 1 August 2018 and can be found at Codes Guidelines Policies.

Good medical practice code of conduct

The Board consulted widely on its revised code of conduct Good medical practice during the year and was delighted to receive more than 800 submissions. Increasing awareness and participation in regulatory policy discussions is helpful. The Board will analyse the feedback and make appropriate amendments before issuing the code.

Guidelines for regulating medical practitioners who provide complementary and unconventional medicine and emerging treatments

In response to concerns about risk of harm to patients, the Board developed and consulted on proposed guidelines for regulating medical practitioners who provide complementary and unconventional medicine and emerging treatments. There was an enormous response to the consultation and the Board received more than 13,000 submissions. Many of the people who responded identified as patients concerned that their right to choose their doctor or treatment options were under threat. This was not the Board’s intention.

The Board will review submissions before finalising the guidelines.

Review of the Good practice guidelines for the specialist international medical graduate assessment process

In 2019, the Board reviewed the Good practice guidelines for the specialist international medical graduate assessment process (the Good practice guidelines), after an external review by Deloitte Access Economics ‘of the performance of specialist medical colleges’ in assessing international medical graduates (IMGs).

The Board-appointed working group that reviewed the guidelines proposed changes, which will be subject to consultation in the next year.

Doctors’ health advisory and referral services

The Board has continued to invest $2 million annually of doctors’ registration fees in supporting Australia’s network of doctors’ health advisory and referral services.

This national network of services is run at arm’s length from the Board and AHPRA and is coordinated by Doctors’ Health Services Pty Ltd, a wholly owned subsidiary of the AMA. Doctors and medical students in all states and territories have access to help and support through this network of services.

Communication, engagement and stakeholder relations

Newsletters

The Board published 10 editions of the Medical Board Update in 2018/19.

Media

The Board welcomes ongoing interest in its work and receives regular media requests for commentary on a range of issues. During the year there was particular interest in the Professional Performance Framework, Good medical practice, the Board’s decision to link the Register of practitioners to tribunal decisions, and the proposed guidelines for regulating medical practitioners who provide complementary and unconventional medicine and emerging treatments.

We also receive regular media requests for commentary about individual practitioners, but the information we can provide about individuals is limited by law.

Meetings with stakeholders

The Board has an active program of stakeholder engagement that includes regular meetings with:

• AMA
• AMC
• Medical Council of New Zealand, and
• specialist colleges through the Council of Presidents of Medical Colleges, and the Medical Council of New Zealand.

During the year, the Board held a forum to update stakeholders on the Board’s work.

For the fifth consecutive year we also met with representatives of the AMA to discuss initiatives introduced to improve the notifications process.

Internal engagement

The Board has a program of internal stakeholder engagement to promote consistency of decision-making and respond to feedback from our decision-makers. This includes an annual conference and regular feedback from state and territory medical boards.

Accreditation

The AMC is the accreditation authority for the medical profession. The AMC develops accreditation standards that are approved by the Board and against which they assess medical schools and specialist colleges. The AMC also reviews and accredits authorities that accredit intern training programs in each state and territory.

The Board considers each of the AMC’s accreditation reports and decides whether to approve the relevant accredited program of study for registration.

The AMC also monitors medical schools, specialist colleges and authorities that accredit intern training programs and provides monitoring reports to the Board.

Future work

Much of the Board’s policy work is long term and spans many reporting years. In 2019/20 the Board plans to focus on:

• delivering the MTS, working with stakeholders to raise awareness of the results and collaborating on how these can be used to strengthen medical training
• ongoing work on the Professional Performance Framework and in particular:
  • consulting on a revised registration standard for CPD, including progressing work on ‘CPD homes’
  • seeking clinical advice to develop a clear idea about what is involved in practical and effective health checks for practitioners aged 70 and over
• finalising the review of Good medical practice
• considering extensive feedback and, if needed, finalising the Guidelines for regulating medical practitioners who provide complementary and unconventional medicine and emerging treatments
• finalising and implementing the Good practice guidelines, and
• further work to improve the management of notifications.

Dr Anne Tonkin, Chair