Medical practice in 2023/24

Workforce

Workforce has been a substantial focus for the Medical Board of Australia.

To address the relevant recommendations flowing from the Kruk review, we have designed a program of reforms to help increase Australia’s appeal in a competitive global market for doctors.

This includes the development of an expedited pathway for registration of specialist international medical graduates (SIMGs). Jurisdictions have set the priority specialties – anaesthesia, general practice, obstetrics and gynaecology, and psychiatry.

Ahpra and the Board set up a taskforce to work on the Kruk recommendations. This includes developing and implementing the new expedited pathway to meet deadlines set by ministers. We consulted with specialist colleges for the priority medical specialties to develop a list of qualifications that will be the gateway to fast-track registration.

Once the pathway is established, international specialists with a qualification on this ‘expedited list’ will be deemed qualified for specialist registration without assessment by medical specialist colleges.

The Board will grant conditional specialist registration to eligible specialist international medical graduates, requiring them to complete a period of supervised practice to confirm their competence. These practitioners will also be required to have training in the Australian health system and in cultural safety. Their registration conditions will be removed when all these requirements have been met.

The Board established a steering committee and a stakeholder advisory group to advise the Board on the development of the expedited pathway. Both groups are supported by a dedicated new project team leading our SIMG reforms.

We developed and carried out a consultation on a new registration standard for specialist registration. This is the regulatory tool we are using to improve the path to specialist registration in Australia while maintaining high standards.

We also completed other significant policy, consultative and process work to meet the challenging 2024 implementation date for the priority specialties in the new pathway.

The Board is partnering with the Australian Medical Council (AMC), which will provide advice on the assessment of qualifications for the expedited pathway, drawing on the expertise of specialist medical colleges.

CPD homes

From 2024, most medical practitioners were required to have a continuing professional development (CPD) home. The Board approved an additional three accredited CPD homes, bringing the total to 20. All of the 16 AMC-accredited specialist medical colleges are accredited CPD homes and a further four non-college CPD homes have been accredited.

The Board has prioritised communication with medical practitioners about the requirement to have a CPD home. Other upgrades to CPD have flowed from the revised registration standard introduced in 2023.

Headline changes include a requirement for doctors to develop a professional development plan and to complete the prescribed mix of educational activities, review of performance and measurement of outcomes in their individual CPD program. While this is a significant change for medical practitioners who were previously doing self-directed CPD, there should be little change for specialists completing college CPD.

Medical Training Survey

More than 23,000 doctors took part in the 2023 Medical Training Survey (MTS). This represents a 54.5% response rate, which continues to build a robust data set that is already being used to improve training.

Broadly, this year’s results were consistent with previous years. Doctors in training reported that medical training in Australia continues to be of high quality, with demonstrable improvements in the quality of supervision, orientation, education and training, and patient safety training. Trainees reported that their workload and hours of work have reduced, and fewer trainees are considering leaving the profession.

The culture of medicine continues to be a problem, with 35% of trainees reporting that they have experienced and/or witnessed bullying, harassment, discrimination or racism. It is deeply concerning that 54% of Aboriginal and Torres Strait Islander trainees experienced or witnessed these behaviours.

The Board commissioned a new report of MTS data, enabling an analysis of trainee experience based on gender. Non-binary trainees reported the highest rates of experiencing bullying, harassment, discrimination or racism. Female trainees consistently reported higher rates of experiencing bullying, harassment, discrimination or racism than male trainees.

We are delighted that we were able to publish static reports of MTS results in December, within two months of the survey closing. Early access to MTS data provided doctors in training and health services with timely access to results they can apply to support positive change.

Cosmetic surgery

The Board and Ahpra put in place a number of regulatory reforms aimed at increasing safety and quality in the cosmetic surgery industry.

The Guidelines for medical practitioners who perform cosmetic surgery and procedures and the Guidelines for registered medical practitioners who advertise cosmetic surgery came into effect on 1 July 2023, creating additional protections for patients.

Ahpra has been auditing practitioners for compliance with the guidelines and the advertising provisions in the National Law. Results show improvements over time as practitioners and the wider industry changed their practice to meet the higher standards.

Legislative changes restricting the use of the title ‘surgeon’ to practitioners with specialist registration in surgery, obstetrics and gynaecology, and ophthalmology were passed this year. Consumers can be confident that only surgically qualified practitioners can call themselves ‘surgeon’.

The Board also established a national committee to handle all matters related to cosmetic surgery, to support consistent, robust decision making.

The Board, along with other National Boards, consulted on a number of guidelines about non-surgical cosmetic practice.

The independently chaired Cosmetic Surgery Oversight Group confirmed that Ahpra and the Board have completed implementation of the 16 recommendations from the Independent review of the regulation of medical practitioners who perform cosmetic surgery.

Other issues of concern

The Board’s telehealth guidelines came into effect on 1 September. They describe good medical practice in telemedicine and acknowledge the important role of telehealth in facilitating access to and delivery of healthcare. The guidelines aim to support practitioners to maintain safe standards of care.

In February, the Board, together with Ahpra and other National Boards, convened a forum addressing issues related to medicinal cannabis. The forum aimed to share information and regulatory intelligence, discuss current risks to the public and optimise collaboration between regulators.

In June, the Medical Board, the Nursing and Midwifery Board, the Pharmacy Board and Ahpra published a joint statement on professional responsibilities for prescribing and dispensing medication. We wanted to address rising concerns that some health practitioners appeared to be putting profit ahead of patient welfare by providing customers with access to a predetermined medicine with inadequate patient assessment and increased risks of unsafe care.

The Board faces ongoing challenges in the coming year, as we design regulatory tools to ensure patient safety protections keep pace with emerging models of care. 

Accreditation

The Australian Medical Council (AMC) is the appointed external accreditation authority for the medical profession. It has a range of functions, including to accredit medical schools and their programs of study, specialist colleges and their programs of study, intern training accreditation authorities and CPD homes.

After a program of study has been accredited by the AMC, the Board decides whether to approve the accredited programs as providing qualifications for registration.

In 2023/24, the Board approved the following:

• Medical school programs of study: 6
• Specialist medical college programs of study: 5
• CPD homes: 3
• Intern training accreditation authorities: 2
• Programs of study for endorsement for acupuncture: 1

The Board assigned the accreditation function for the medical profession to the AMC for a new period of five years from 1 July 2024.

Stakeholder engagement

Newsletters and media

The Board published 10 editions of the Medical Board Update and two editions of a newsletter for medical students.

The Board responded to many media requests for comment on a range of issues. We also received requests for comment about individual practitioners, and answered with limited information, guided by law.

Meetings with stakeholders

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

• Australian Medical Association (AMA) – annual workshop held 5 December
• 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 more than $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 in decision making and respond to feedback from our decision makers, including:

• regular meetings with the chairs of state and territory board
• the internal MBA annual conference for all members of the Board and some Ahpra staff.

Medical school education packages

The Board published a suite of education resources on regulation and professionalism for medical students in Australia.

The purpose of the resources is to dispel myths and misconceptions about regulation and to help medical students understand the regulation of medical practitioners in Australia. They provide an optional resource for medical schools and align with their ‘Professionalism and leadership’ curriculum.

The resources are published on the Board’s website. A working group of the Medical Board and Ahpra staff developed the packages.

We also trialled interactive workshops for final year medical students that will be offered to all medical schools.

Consultations and registration standards

The registration standard Granting general registration as a medical practitioner to Australian and New Zealand medical graduates on completion of postgraduate year one training was approved by health ministers on 13 December and came into effect in 2024.

The Board undertook public consultation on the draft Specialist registration standard.

The Board, together with other Boards, consulted on the following:

• Criminal history registration standard
• English language skills registration standard
• Guidelines for registered health practitioners who advertise non-surgical cosmetic procedures (advertising guidelines)
• Guidelines for nurses who perform non-surgical cosmetic procedures (nursing practice guidelines)
• Guidelines for registered health practitioners who perform non-surgical cosmetic procedures (shared practice guidelines).

New fields and specialties

The Board consulted on a joint application from the Australian College of Rural and Remote Medicine and the Royal Australian College of General Practitioners seeking recognition of rural generalist medicine as a new field of specialty practice within the current specialty of general practice.

Dr Anne Tonkin AO, Chair