2021/22 annual summary

Regulating

From the Chair

The 2021/22 year was challenging for many of us. The impact of COVID-19 has been felt deeply, both professionally and personally. Many of you will be feeling fatigued and maybe even disillusioned.

The Medical Board of Australia thanks you for your extraordinary work serving our communities under challenging circumstances.

Issues this year

COVID-19 continued to feature in our work with a range of policy decisions to support a surge workforce and to increase flexibility. The Board is delighted with the ongoing success of the Medical Training Survey (MTS) and is grateful for the support of doctors in training and other stakeholders. We are disturbed by MTS results across successive years highlighting unacceptable rates of bullying, harassment, discrimination and racism. Our Culture of Medicine Symposium aimed to build a common understanding of current problems and a shared commitment to a different future.

We continued our work to strengthen continuing professional development and improve complaints handling, and with Ahpra have commissioned an independent review into cosmetic surgery.

Regulatory responses to COVID-19

The Board made a number of decisions to support a surge workforce, reduce red tape and support medical practitioners by:

• establishing an additional pandemic sub-register, adding to the pool of doctors potentially able to support the COVID-19 response
• introducing flexibility for 2022 interns whose internship has been disrupted directly as a result of COVID-19
• publishing guidance and alerting practitioners about the Therapeutic Goods Administration’s restrictions on prescribing ivermectin for COVID-19
• in partnership with Ahpra, other National Boards, the Health Care Complaints Commission, the Office of the Health Ombudsman and the Therapeutic Goods Administration, publishing a statement for patients and health consumers to support informed decision-making, particularly about sorting fact from fiction
• with Ahpra and the other National Boards, publishing a statement Facilitating access to care in a COVID-19 environment: guidance for health practitioners
• agreeing to temporarily accept additional English language tests.

Cosmetic surgery independent review

The Medical Board and Ahpra commissioned an independent review of patient safety issues in the cosmetic sector, including how to strengthen riskbased regulation of practitioners in an increasingly entrepreneurial part of the profession.

Mr Andrew Brown, previously the Queensland Health Ombudsman, led the review, which included public consultation.

Professional Performance Framework

The Board’s Professional Performance Framework continues to guide the work of the Board. It aims to support registered medical practitioners in Australia to practise competently and ethically throughout their careers. It has five pillars:

1. Strengthened CPD requirements
2. Active assurance of safe practice
3. Strengthened assessment and management of practitioners with multiple substantiated complaints
4. Guidance to support practitioners
5. Collaborations to foster a culture of medicine that is focused on patient safety, is based on respect and encourages doctors to take care of their own health and wellbeing

Most of the work described below relates to at least one pillar.

Medical Training Survey

The Medical Training Survey (MTS) is becoming a feature of the landscape for doctors in training. This year, 55% of doctors in training (more than 21,000) did the survey. Results show that the quality of training remains high, with improvements reported in all aspects of the quality of supervision. Of the surveyed trainees, 80% would recommend their current training position to other trainees.

Once again, we are deeply concerned about trainee feedback about the culture of medicine: 35% of doctors in training reported they had experienced or witnessed bullying, harassment or discrimination (including racism). It is even worse for Aboriginal and Torres Strait Islander doctors in training, with 52% reporting that they had experienced or witnessed these unacceptable behaviours.

Results are at www.medicaltrainingsurvey.gov.au. The MTS is one of the important ways the Board fosters collaborations to improve the culture of medicine.

Symposium on the culture of medicine

Consistently disturbing findings from the Medical Training Survey across three years led the Board to convene a symposium on the culture of medicine on 27 May. Strong evidence that poor culture is associated with poor patient outcomes places the culture of medicine firmly in scope for the Board.

The symposium shared evidence of poor culture but focused primarily on fostering a commitment to positive change.

Conference participants identified improved awareness and understanding of cultural safety, meaningful action on racism and collaborations to help effect change as a focus for future effort. We shared ideas about what we might do together to reshape the complex system that creates the culture of medicine in this country.

CPD registration standard

Health Ministers approved the revised CPD (continuing professional development) registration standard, which is evidence-based. The revised standard aims to support medical practitioners to do high-value CPD that they can incorporate into their day-to-day practice and create a real and positive impact. An implementation group was established.

Specialist colleges will transition to become CPD homes by the end of 2022. Doctors who do their CPD through their specialist college will therefore meet the new CPD standard from 1 January 2023. Others have until 2024 to meet the revised standard.

Health checks for late career practitioners

The Board’s plan for regular health checks for practitioners aged 70 and over reflects expert advice that increasing age is a known risk factor for poor performance. We developed a draft registration standard for these health checks and are preparing a Regulation Impact Statement for consultation. We expect that most late career practitioners will continue to practise in their usual way after health checks are introduced.

Guidance to support practitioners

Registration standard for acupuncture endorsement

Medical practitioners who want to use the protected title ‘acupuncturist’ must have their registration endorsed for acupuncture by the Medical Board of Australia or also be registered with the Chinese Medicine Board of Australia. The Medical Board’s revised registration standard for Endorsement of registration for acupuncture for registered medical practitioners defines the requirements, was approved by Ministers and took effect on 1 July 2022.

International medical graduates in hospitals

The Board published additional guidance for hospitals who employ international medical graduates (IMGs). The guidance supplements the Board’s Guidelines: supervised practice for international medical graduates, which are based on the general practice environment. The information provides a framework for hospitals to propose alternative supervision arrangements.

Guidance for IMGs with limited registration for research

The Board published information for IMGs applying for limited registration for research positions. It provides guidance about the evidence an applicant must provide to show they meet the registration requirements.

Supervised practice framework

The framework applies to medical practitioners when supervision is used for the purposes of eligibility or suitability for registration. For example, when doctors are returning to practice after a prolonged absence, changing their scope of practice, or when they are not able to meet a requirement of a registration standard. It will also apply when a doctor is required to complete a period of supervised practice after a complaint.

The supervised practice framework does not apply to IMGs with limited or provisional registration, to interns with provisional registration or to vocational (specialist) trainees. Supervision requirements for these medical practitioners have not changed.

Telehealth

The Board reviewed and revised its Guidelines on technology-based consultations. It will consult on these in 2022/23.

Stakeholder engagement

Newsletters and media

The Board published 10 regular editions of the Medical Board Update and two editions of its medical student newsletter.

The Board responds to many media requests for comment on a range of issues. We also receive requests for comment about individual practitioners, but provide limited information, as permitted by law.

Meetings with stakeholders

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

•  Australian Medical Association (AMA)
• Australian Medical Council (AMC)
• Medical Council of New South Wales
• Medical Council of New Zealand
• specialist colleges through the Council of Presidents of Medical Colleges
• professional indemnity providers
• Drs4Drs – the Board provides about $2m funding annually for state-based health services for all medical practitioners and students.

Internal engagement

The Board has a program of internal stakeholder engagement to promote consistency of decisionmaking and respond to feedback from our decisionmakers, including:

• regular meetings with the Chairs of state and territory boards
• a registration workshop
• the MBA annual conference – an online conference for all members of the Board and Ahpra staff.

Stakeholder engagement is a cornerstone of our regulatory approach and features across all pillars of the Professional Performance Framework.

Accreditation

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

New fields and specialties

The Board progressed rural generalist medicine as a new field of specialty practice within general practice to the second stage of assessment, which includes a detailed assessment, including public consultation.

The Board sought advice from the AMC about an application for recognition of clinical forensic medicine as a new specialty.

Managing complaints

The Board and Ahpra appreciate the enormous stress that many medical practitioners experience when a notification (complaint) is made about them. Our own research tells us that the longer it takes to resolve a notification, the more distressing it is for everyone involved.

The Board continues to make changes to improve the management of complaints, including:

1. changing the scope of the Sexual Boundaries Notifications Committee to include matters involving family violence
2. establishing a national committee to deal with all COVID-19-related notifications
3. continuing its risk-based approach, by dealing with low-risk matters quickly and focusing resources on high-risk matters; the Notifications Assessment Committee meets six times each week – a measure of the complaints-handling workload.

Dr Anne Tonkin