2022/23 annual summary

Medical practice in 2022/23

Registration

• 136,742 medical practitioners
  • Up 3.6% from 2021/22
  • 15.6% of all registered health practitioners
• 8,357 first-time registrants
  • 4,146 domestic (including new graduates)
  • 4,211 international
• 0.6% identified as Aboriginal and/or Torres Strait Islander
• 45.9% female; 54.1% male

Age

 

Specialties	Registrants
Addiction medicine	199
Anaesthesia	5,919
Dermatology	657
Emergency medicine	3,326
General practice	34,934
Intensive care medicine	1,164
Medical administration	354
Obstetrics and gynaecology	2,280
Occupational and environmental medicine	294
Ophthalmology	1,093
Paediatrics and child health	3,811
Pain medicine	405
Palliative medicine	473
Pathology	2,362
Physician	13,161
Psychiatry	4,540
Public health medicine	450
Radiation oncology	472
Radiology	3,044
Rehabilitation medicine	626
Sexual health medicine	134
Sport and exercise medicine	163
Surgery	6,484
Total	86,345

Regulation

• 5,615 notifications lodged with Ahpra about 4,494 medical practitioners
• 9,938 notifications about 7,761 medical practitioners made Australia-wide, including HPCA and OHO data
• 5.7% of the profession Australia-wide

Sources of notifications

 

Most common types of complaints

 

Notifications closed

 

• 148 immediate actions taken
• 305 mandatory notifications received
  
  • 139 about impairment
  • 100 about professional standards
  • 50 about sexual misconduct
  • 16 about alcohol or drugs
• 872 practitioners monitored for health, performance and/or conduct during the year
• 127 criminal offence complaints made
• 78 notifications finalised at tribunal
• 3 matters decided by a panel
• 85 appeals lodged

A report from the Chair

The Medical Board of Australia had a particularly busy year. Much of our work was high profile and contentious, but we held our focus on public safety. Key achievements include reform of the cosmetic surgery industry and strengthening telehealth guidelines. Workforce issues have emerged as a significant, ongoing challenge.

Cosmetic practice

Ahpra and the Board commissioned Mr Andrew Brown to conduct an independent review of the regulation of medical practitioners who perform cosmetic surgery. We were appalled by media reports that raised concerns about the alleged conduct of some doctors, including alleged serious hygiene breaches, patient safety issues, poor patient care, unsatisfactory surgical outcomes and aggressive and inappropriate advertising.

The review’s final report was published in September. The Board and Ahpra accepted all 16 recommendations. Our work this year was dominated by cosmetic practice, and by developing a package of reforms aimed at increasing public safety, improving practice, lifting standards and ensuring better information is accessible to foster safer consumer choices.

The Board took the following actions:

1. Created an area of practice endorsement to help consumers know who is trained and qualified to perform cosmetic surgery safely. Demand for cosmetic surgery already outstrips supply by surgeons. The area of practice endorsement aims to provide a safe alternative for patients who will continue to seek cosmetic procedures by doctors who are not surgeons. It creates a high standard, where there has been none. The work to create an area of practice endorsement has included:
   a. developing a registration standard that defines requirements for endorsement of registration, which has been approved by Ministerial Council
   b. approving accreditation standards developed by the Australian Medical Council that set the standards for accreditation of cosmetic surgery programs for endorsement.
2. Developed revised Guidelines for medical practitioners who perform cosmetic surgery and procedures.
3. Developed new guidelines for cosmetic surgery advertising.
4. Advised ministers on who should be able to call themselves ‘surgeon’.
5. Encouraged practitioners to report concerns about patient safety, through guidance.
6. Centralised the management and decision-making of all cosmetic practice complaints.

With Ahpra, we have also:

1. Established a hotline for enquiries and complaints about cosmetic practice.
2. Proactively audited advertising compliance.
3. Published an advertising hub with information for practitioners and consumers.

The new guidelines took effect from 1 July 2023.

Telehealth guidelines

The Board updated its telehealth guidelines to close the gap that has sprung up between online healthcare business models, including prescribing, and good medical practice.

Under the revised guidelines:

• telehealth consultations will continue as an important feature of healthcare in Australia
• real-time doctor–patient consultations remain key to safe prescribing
• providing healthcare, including prescribing, issuing certificates and referring, via questionnaire-based asynchronous web-based tools in the absence of a real-time patient–doctor consultation, is not considered good practice.

The new guidelines will be effective from 1 September 2023.

Medical Training Survey

In 2022, 23,000 doctors in training (56.6% response rate) completed the Medical Training Survey (MTS), helping build a robust national dataset to drive improvements in medical training.

The results were broadly consistent with previous years, with some small but statistically significant variations in year-on-year results. Changes included an increase in trainee workload, a dip in the quality of teaching, a drop in the number of trainees who would recommend their current training position or organisation, and an increase in the number of trainees considering a future career outside medicine.

The culture of medical training is a continuing concern, with 55% of Aboriginal and Torres Strait Islander trainees reporting that they have experienced and/or witnessed bullying, harassment, discrimination and racism, compared with 34% of all trainees who have.

Fault lines in the culture of medicine revealed by the MTS warrant ongoing, collaborative solutions from agencies across the health sector. The Board will continue the policy and professional standards work that will underpin sector-wide action, in collaboration with the frontline organisations that hold the keys to lasting cultural change.

The MTS results are published in static reports and are accessible through an online reporting tool on the MTS website at www.medicaltrainingsurvey.gov.au.

CPD homes

The Board’s Continuing professional development (CPD) registration standard requires medical practitioners to have a CPD home to help them with their CPD. All Australian Medical Council–accredited specialist medical colleges have been approved as CPD homes, so all practitioners doing college CPD will be compliant with the Board’s standard.

CPD homes are accredited by the Australian Medical Council (AMC) and approved by the Board. An additional CPD home, Doctorportal Learning, which can provide quality-assured CPD programs to doctors, was approved in 2022.

Prospective CPD homes can apply to the AMC for accreditation and must meet robust accreditation standards.

Practitioners will be required to have a CPD home by 1 January 2024.

Workforce

Medical workforce shortages were a key issue for governments in December. To help chart a course, Ms Robyn Kruk AO was appointed in December to lead an independent review of Australia’s health regulatory settings. The review’s interim report was published and recommended:

• cutting assessment red tape, allowing more international practitioners to enter and work in Australia safely and sooner
• fast-tracking some approvals, through greater recognition of international qualifications from comparable health systems
• reviewing current standards, including English language and recency of practice requirements.

The Board has started to consider how it can fast-track practitioners to registration while maintaining public confidence and safety. This is likely to include a review of the specialist international medical graduate pathway, which will be a feature of the Board’s 2023 work.

Accreditation

The Australian Medical Council 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 2022/23, the Board approved the following:
Medical school programs of study - 12
Specialist medical college programs of study - 7
Intern training accreditation authorities - 2

The Board also approved revised accreditation standards for primary medical programs.

New registration standards, codes or guidelines

As well as the regulatory reforms in cosmetic practice and telehealth, the Board also consulted on and recommended that ministers approve a revised registration standard for Granting general registration as a medical practitioner to Australian and New Zealand medical graduates on completion of postgraduate year one training.

This revised standard defines the requirements that Australian and New Zealand medical graduates must meet to become eligible for general registration. This includes the requirement to complete a period of supervised practice and puts the National Framework for Prevocational (PGY1 and PGY2) Medical Training into effect. It removes mandatory rotations in medicine, surgery and emergency medical care and replaces them with a range of broad-based experiences.

Over this year, the Board, with other National Boards, consulted on the English language registration standard and approved a range of additional tests.

Stakeholder engagement

Newsletters and media

The Board published 11 editions of the regular Medical Board Update.

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

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 in decision-making and respond to feedback from our decision-makers, including:

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

Medical school education packages

The Board published new education resources on regulation and professionalism for medical students in Australia.

The educational resources aim to dispel myths and misconceptions about regulation and to help medical students understand the regulation of medical practitioners in Australia. They are an optional resource for medical schools and align with the medical school ‘Professionalism and leadership’ curriculum. They are published on the Board’s website.

New fields and specialties

The Board consulted on a proposal to recognise genetic pathology as a new field of specialty practice within pathology.

COVID-19

While the Australian community is learning to live with COVID-19, there continue to be impacts on our healthcare services. The Board agreed to provide some additional flexibility to interns who have had to take leave for COVID-19 illness or to isolate, reducing their service requirements to 45 weeks.

Dr Anne Tonkin AO, Chair