2019/20 annual summary

Snapshot of the profession

Regulating the profession

Notifications

A report from the Chair

Issues this year

The COVID-19 pandemic has had an enormous impact on the medical profession during the latter part of 2019/20 and this is likely to continue. The Medical Board of Australia has made a number of pragmatic decisions to ease the administrative burden for practitioners and the health system, while maintaining patient safety.

The Board is very proud to have successfully run the first Medical Training Survey during 2019/20. This was a collaborative effort with a lot of support from doctors in training, their employers and supervisors. 

We progressed work on the Professional Performance Framework, consulted on a number of guidelines and worked in partnership with Ahpra to improve the notifications experience for notifiers and practitioners.

Regulatory response to COVID-19 

As we faced the enormous public health challenge of COVID-19, the Board recognised that doctors would have an important role in supporting the health system and dealing with sick and anxious patients. The Board made a series of decisions to boost the medical workforce and ease administrative demands on health services, while maintaining public safety. These responses included:

• relaxing requirements for medical practitioners to meet the continuing professional development (CPD) registration standard for 2020
• easing the general registration requirements for interns, by reducing timeframes and relaxing accredited term requirements if an individual’s internship was disrupted directly as a result of COVID-19
• making registration requirements for international medical graduates (IMGs) more flexible, by reducing requirements for change of circumstances applications and not requiring IMGs to demonstrate progression towards general or specialist registration if they could not sit an Australian Medical Council (AMC) or college examination or assessment
• clarifying the conditions under which IMGs with limited registration can practise telehealth
• in partnership with Ahpra, establishing the pandemic response sub-register that enabled recently retired practitioners to automatically return to the Register of practitioners and therefore to practise
• providing advice that, if a notification was received, the Board would consider the circumstances in which the doctor was practising, particularly if affected by COVID-19
• clarifying ‘scope of practice’ and confirming that the Board does not restrict practitioners’ practice.

Policy and project updates

Medical Training Survey

The Board and Ahpra ran the first Medical Training Survey (MTS) during the 2019 renewal period. Nearly 10,000 doctors in training took part in the MTS, creating the first national, comprehensive picture of medical training in Australia. 

The MTS results provide an evidence base that educators, employers and stakeholders across the health sector can use to improve the culture of medicine and further strengthen medical training.

Trainee responses are presented in a series of static reports and the data are also accessible through an online reporting tool, available on the MTS website.

The survey results found that, in general, trainees rate their training, clinical supervision and teaching very highly. About 75% of trainees work more than 40 hours a week, but many value the training opportunities this provides. Most trainees would recommend their current training post and nearly all intend to continue with their training program. There are opportunities to improve trainee access to health and wellbeing support programs, and bullying and harassment remain prevalent.

More than one in three trainees report having experienced or witnessed bullying, harassment and/or discrimination. Only one-third of those who reported experiencing it, reported it.

There is work to do to better support Aboriginal and/or Torres Strait Islander specialist trainees and improve their experience of medical training. Survey findings show Aboriginal and/or Torres Strait Islander trainees are nearly twice as likely to have experienced and witnessed bullying, harassment and discrimination in the last 12 months. 

The Board and Ahpra are grateful for the support and contributions of many doctors in training and other stakeholders. The MTS has been a team effort. We will continue to run the MTS and hope that participation rates continue to increase as doctors in training gain confidence in the survey.

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: 

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

CPD registration standard

The Board consulted on a revised registration standard for continuing professional development (CPD). The standard is built on existing arrangements and proposed strengthened CPD requirements based on evidence. The standard proposed that medical practitioners:

• complete a minimum of 50 hours of CPD each year that includes a mix of:
  • at least 25% on activities that review performance
  • at least 25% on activities that measure outcomes
  • at least 25% on educational activities
• have a CPD home and participate in its CPD program
• do CPD that is relevant to their scope of practice
• base the CPD on a personal professional development plan.

The Board will finalise the registration standard in the next year and submit it to the Ministerial Council for approval.

Health checks for late career practitioners

The Board’s Clinical Advice Committee progressed work on what should be involved in pragmatic and effective health checks for late career practitioners (doctors aged 70 years and older). The committee reported to the Board during the year. The Board will develop a registration standard, taking into consideration the committee’s recommendations and will consult widely on the standard.

New and revised guidelines

Guidelines for advertising regulated health services

Together with the other 14 National Boards, the Medical Board consulted on revised Guidelines for advertising regulated health services. The guidelines were developed to explain the advertising requirements in the National Law and to help advertisers (including registered health practitioners) meet these requirements and advertise responsibly. The review aimed to make sure the guidelines are as contemporary, relevant and effective as possible.

The guidelines were approved and will be published and implemented during 2020/21.

Guidelines for mandatory notifications

Changes to the mandatory notification provisions in the National Law came into effect during the year. To support practitioners to better understand their obligations, the 15 National Boards consulted on revised Guidelines for mandatory notifications.

Ahpra and the Board also developed and delivered educational resources to support the changes to the legislation. We are grateful for the support of many stakeholders who helped us publicise the changes and dispel many of the myths about mandatory reporting.

The new guidelines came into effect during the year.

Guidelines for registered health practitioners and students in relation to blood-borne viruses

The Board consulted on Guidelines for registered health practitioners and students in relation to blood-borne viruses. The guidelines were published, coming into effect on 6 July 2020.

Consultation on revised Good practice guidelines for the specialist international medical graduate assessment process

These good practice guidelines aim primarily to support specialist colleges as they assess specialist IMGs. The guidelines were revised after a Deloitte Access Economics review of the performance of the specialist medical colleges in their assessment of specialist IMGs. 

Stakeholder engagement

Newsletters

The Board published nine regular editions of the Medical Board update in 2019/20 and two newsletters dedicated to the Board’s response to COVID-19. 

Media

The Board receives regular media requests for comment on a range of issues. During the year there was interest in mandatory reporting, the MTS and the Professional Performance Framework. 

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

Meetings with stakeholders

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

• Australian Medical Association (AMA) 
• AMC 
• Medical Council of New South Wales 
• Medical Council of New Zealand 
• specialist colleges through the Council of Presidents of Medical Colleges.

During the year, the Board held a forum with key stakeholders about the results of the MTS. 

For the sixth 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 regular meetings with the Chairs of state and territory boards and the Chair of the National Board visiting each state and territory board. There are also regular meetings with Ahpra.

Other news

Notifications process

Managing notifications (complaints) will always be fraught and we know that those involved are unlikely to be happy with the process. Notifiers tend to believe that the Board is on the doctor’s side while doctors tend to feel that the Board and Ahpra are on the notifier’s side.

These responses are understandable, but we aim to be impartial, fair and transparent. We also want to deal with notifications as quickly as possible.

The Board worked with Ahpra to further fine-tune our risk-based approach. We have established processes to deal with lower risk matters more quickly and less formally, with more communication with notifiers and practitioners. This has been supported by the Board’s national Notifications Committee: Assessment. 

The work of the Sexual Boundaries Notifications Committee has also continued, with increased numbers of notifications. During the year, we commissioned Professor Ron Paterson to review the effectiveness of implementing the recommendations in the Independent review of the use of chaperones to protect patients in Australia, published in July 2020.

Accreditation

The Australian Medical Council (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. 

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. 

Dr Anne Tonkin, Chair