February 2022

• Chair’s message 
• Medical Board of Australia news
  • 2021 Medical Training Survey
    • Medical Training Survey highlights COVID-19 impacts, high quality training and work to do on culture
  • National Medical Board membership 
    • Health Ministers make Medical Board appointments
  • Medical Board vacancies
    • Interested in joining a territory Medical Board?
  • Lessons learned
    • Mixed drug toxicity
  • Cosmetic surgery
    • Independent review of the regulation of health practitioners in cosmetic surgery underway
  • Accreditation
    • Providing high quality education and training
  • Quarterly registration data
    • Latest registration data published
• News and alerts
  • Supervised practice framework now in effect
  • What’s in a title?
  • Facilitating access to care in a COVID-19 environment: Guidance for health practitioners
  • Media statement – Unqualified medical intern at Bankstown hospital convicted
• Medical regulation at work
  • Latest tribunal decisions published 
• Contacting the Board

Chair’s message 

The last two years have placed unprecedented demands on our health system, on many of us as individuals and on our teams. Thank you for the courage you have shown and the strength you have drawn on to serve your communities. We know that the situation recently got worse, with more states and territories dealing with the Omicron outbreak. Medical practitioners are doing an amazing job, which is coming at a personal cost to many of you. Please take care of yourselves and each other. Seek support and remember that in any interactions we have with you, we will take into account the extraordinary circumstances in which you are working, and the heavy demands being made of you.

Dr Anne Tonkin
Chair, Medical Board of Australia

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Medical Board of Australia news

2021 Medical Training Survey

Medical Training Survey highlights COVID-19 impacts, high quality training and work to do on culture

COVID-19 adversely affected medical training in the states and territories worst hit by the pandemic and had a mixed impact in other states and territories, according to results of the 2021 Medical Training Survey (MTS).

The 2021 MTS results are broadly consistent with previous years and while there is a lot going well in medical training, there are some important issues that require attention.

Again in 2021, medical trainees called out workplace culture as a serious issue and disappointingly, this has not improved this year.

The MTS is an annual, national profession-wide survey of medical training designed to give trainees a voice on medical training, to inform continuous improvement. The 55% survey response rate has generated a solid evidence base and a robust national dataset that will continue to shape improvements to training.

2021 MTS results show that all aspects of the quality of supervision have improved since 2020 and trainees report receiving more regular and more useful feedback, both formal and informal. Workforce issues continue, with 45% of trainees reporting they ‘never/sometimes’ got paid for unrostered overtime, and 49% rated their workload as heavy/very heavy.

There was no improvement in the percentage of trainees reporting that they had experienced and/or witnessed bullying, harassment and/or discrimination (including racism) in training (35%), with the most common sources reported to be senior medical staff, followed by nurses/midwives and patients/carers/families.

There is also a disturbing and unacceptable difference in the incidence of these issues reported by Aboriginal and Torres Strait Islander doctors in training. Racism in healthcare is never acceptable and we all have to do better. MTS results show that 17% more Aboriginal and Torres Strait Islander trainees reported experiencing and/or witnessing bullying, harassment and/or discrimination and 49% reported a moderate or major impact on their training (compared with 38% nationally).

MTS results show a clear link between professional behaviours and medical training, with 38% of trainees who experienced bullying, discrimination and/or harassment reporting moderate or major adverse impacts on their training.

MTS results are available online through the data dashboard published on the Medical Training Survey website.

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National Medical Board membership

Health Ministers make Medical Board appointments

Australian Health Ministers have appointed members to the Medical Board of Australia. Terms on National Boards are for three years and existing members can apply for reappointment.

Dr Anne Tonkin, practitioner member, South Australia, has been reappointed Chair of the Medical Board of Australia for a second term.

The following current National Board members have been reappointed:

• Associate Professor Stephen Adelstein, practitioner member, New South Wales
• Mr Mark Bodycoat, community member, South Australia
• Dr Kerrie Bradbury, practitioner member, Australian Capital Territory
• Dr Samuel Goodwin, practitioner member, Northern Territory
• Ms Eileen Jerga AM, community member, Australian Capital Territory
• Dr Andrew Mulcahy, practitioner member, Tasmania
• Dr Susan O’Dwyer, practitioner member, Queensland
• Ms Michelle Wright, community member, Victoria.

The following new members have been appointed:

• Ms Jayde Geia, community member, Queensland
• Dr Daniel Heredia, practitioner member, Western Australia
• Dr Debra O’Brien, practitioner member and Chair of the Victorian Board of the Medical Board of Australia.

We thank the following members who finished their term on the Board:

• Professor Richard Doherty
• Associate Professor Hannah McGlade
• Professor Con Michael AO.

Read more about the Medical Board members on the Medical Board website. A full list of the recent appointments for all National Boards is in the Health Ministers’ meeting communiqué available on the Ahpra website.

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Medical Board vacancies

Interested in joining a territory Medical Board?

Applications are open for medical practitioners and community members to fill vacancies on two medical boards.

Australian Capital Territory

• two practitioner members
• one community member.

Northern Territory

• two practitioner members, including the Chair
• two community members.

Applications close 27 February 2022. More information is available on Ahpra’s Statutory appointments page.

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Lessons learned

Mixed drug toxicity

Sharing case studies about issues that come before the Board can provide insights into some of the issues facing the profession. The case studies are de-identified and usually combined, except for tribunal hearings which are open.

Managing patients with combinations of physical and mental health illness, chronic pain, and drug dependence is often challenging. These patients are also at high risk of death from drug toxicity.

A woman in her 50s who had lived alone and been on a disability pension died, triggering a report to the Board. Her doctor had treated her for chronic back pain and depression for many years and she had a history of intravenous drug use in her 20s.

A post-mortem drug screen found she had high levels of oxycodone and diazepam, as well as therapeutic levels of fentanyl and mirtazapine. It was determined that her death was accidental, from mixed drug toxicity.

After investigating, the Board identified a number of issues in relation to the doctor’s prescribing practice, including:

1. failing to update health department permits for ongoing opioid therapy
2. not checking the patient for physical signs of drug misuse
3. not regularly checking for ‘doctor shopping’ using the state’s prescription monitoring system
4. not limiting the quantity of medication that could be dispensed at one time
5. prescribing the patient combinations of sedative medications with significant potential interactions
6. making minimal attempts to reduce the patient’s opioid/benzodiazepine dosage, and
7. not referring the patient for multidisciplinary care including from pain, psychiatric or addiction services.

This case illustrates the importance of careful assessment, communication, documentation and compliance with prescribing requirements when managing patients with complex needs. The Board’s Code of conduct offers guidance to medical practitioners. State and territory health departments also publish information to help practitioners to comply with prescribing requirements in their jurisdiction.

Other resources available include the Royal Australian College of General Practitioner’s Prescribing drugs of dependence in general practice.

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Cosmetic surgery

Independent review of the regulation of health practitioners in cosmetic surgery underway

An independent review of the regulation of health practitioners in cosmetic surgery commissioned by Ahpra and the Medical Board of Australia in 2021 has started. The review is:

• looking at patient safety issues in the cosmetic surgery sector, including how to strengthen risk-based regulation of practitioners in the industry
• ensuring Ahpra and the National Boards’ regulatory approach keeps pace with rapid changes in the cosmetic surgery industry, and
• making recommendations about actions that will better protect the public.

Mr Andrew Brown, previously the Queensland Health Ombudsman, is the lead reviewer, supported by an expert panel made up of:

• Mr Alan Kirkland – CEO, CHOICE
• Conjoint Professor Anne Duggan – Chief Medical Officer, Australian Commission on Safety and Quality in Health Care
• Ms Richelle McCausland, National Health Practitioner Ombudsman.

The review will call for submissions soon and report its findings and recommendations in mid-2022.

We have published more information about the review in FAQs on the Ahpra website.

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Accreditation

Providing high quality education and training

The Board has approved the following:

Specialist medical college program of study

Medical school program of study

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Quarterly registration data

Latest registration data published

The Board publishes data each quarter on the medical profession. Data are broken down by state and territory, registration type and for specialists, by specialty and field of specialty practice. The latest data are available on our website under Statistics on the News page.

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News and alerts

Supervised practice framework now in effect

The Supervised practice framework (the framework) is now in effect for 12 professions including medical practitioners.

This framework does not apply to international medical graduates with limited or provisional registration, to interns with provisional registration or to vocational (specialist) trainees. Supervision requirements for these medical practitioners have not changed.

The framework outlines the National Boards’ expectations and supports supervisees, supervisors and employers to understand what is necessary to effectively carry out supervised practice. It also includes the principles that underpin supervised practice and the levels of supervised practice.

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.

To support supervisees, supervisors and employers to apply the framework, the National Boards and Ahpra have developed a set of frequently asked questions and two flowcharts. The flowcharts outline the key steps of supervised practice for registration requirements or suitability and eligibility requirements and for supervised practice following a complaint (notification).

There is also a Fact sheet: Supervised practice – transition arrangements about the transition arrangements for supervisees and supervisors who already have supervised practice arrangements in place or who sent their documents to Ahpra or the Board before 1 February 2022.

The framework and additional information can be found on the Board’s Supervised practice framework page and in the news item.

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What’s in a title?

There’s been some debate lately about protected titles and how they protect the public. Here are some facts to inform the discussion:

What is a protected title?

In Australia, the titles of registered health professions are 'protected' by law. This means patients know that when someone calls themselves a 'medical practitioner', they can expect that person is appropriately trained and qualified in medicine, registered and expected to meet safe and professional standards of practice.

The Health Practitioner Regulation National Law, as in force in each state and territory, determines protected titles and only Health Ministers can change them, by changing the law.

What are protected specialist titles?

Medicine, dentistry and podiatry have approved specialist titles for their professions. Practitioners who use these titles have additional training and qualifications in a specialty field. For example, a medical practitioner who has additional training and qualifications in neurosurgery and meets the requirements for specialist registration, can use the protected title ‘specialist neurosurgeon’ or simply refer to themselves as a ‘neurosurgeon’.

Anyone can check if a practitioner has specialist registration online on the Register of practitioners.

What about cosmetic surgery?

There has been quite a lot of debate about the use of the title ‘cosmetic surgeon’. In fact, cosmetic surgery is not a recognised medical specialty and cosmetic surgeon is not a protected specialist title, which means that any medical practitioner can call themselves a ‘cosmetic surgeon’. When they do, they are still expected by law to exercise their professional judgement and work within the scope of their individual competence, education and training.

Health Ministers are currently consulting on whether ‘surgeon’ should be a protected title under the National Law, and in what specialties it should apply, or if other changes should be made to make this clearer. More information on the consultation is on the Engage Victoria website.

What if a practitioner modifies a protected or specialist title?

If a practitioner is registered to practise in any of the 16 registered health professions, whether they hold specialist registration or not, they are expected to act safely and professionally, in good faith and within the scope of their expertise. They can’t mislead patients about the scope of their expertise.

It’s a criminal offence for someone who isn’t a registered health practitioner to use a protected or specialist title. There are significant penalties if they do, including possible jail terms.

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Facilitating access to care in a COVID-19 environment: Guidance for health practitioners

Medical practice can be challenging and COVID-19 has made it even more challenging for many doctors. We commend the sustained efforts of doctors and other health practitioners who have led the remarkable public health response to the COVID-19 pandemic in Australia.

To support good practice in the pandemic, we have published guidance that reinforces existing expectations and provides shortcuts to other relevant publicly available information.

Good practice involves keeping health practitioners, staff and patients safe when caring for people. National Boards also expect registered health practitioners to facilitate access to care, regardless of someone’s vaccination status. This means that people can’t be denied care if steps can be taken to keep the person, health practitioners and their staff safe.

The guidance is published on the Ahpra website.

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Media statement – Unqualified medical intern at Bankstown hospital convicted

Ahpra published this media statement this month:

Unqualified medical intern at Bankstown hospital convicted – A woman who worked as a medical intern at a Sydney hospital despite not being qualified or registered to practise has been convicted.

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Medical regulation at work

Latest tribunal decisions published 

There are important lessons in tribunal decisions about registered medical practitioners. The Medical Board of Australia refers the most serious concerns about medical practitioners to tribunals in each state and territory. These decisions were published recently:

• the Victorian Civil and Administrative Tribunal has reprimanded a former medical practitioner, disqualified him from applying for registration for six years and prohibited him from using the title ‘Dr’ for issuing false vaccination exemption certificates (Medical Board of Australia v Piesse)
• the State Administrative Tribunal in Western Australia has reprimanded a general practitioner and put conditions on his registration for sending inappropriate social media messages to a patient (Medical Board of Australia and Menon)
• the Victorian Civil and Administrative Tribunal decision about a medical practitioner disqualified from applying for registration for three months for her obstetric care of patients in a Victorian hospital is now accessible online (Medical Board of Australia v Lines).

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Publication of panel, court and tribunal decisions 

Ahpra, on behalf of the 15 National Boards, publishes a record of panel, court and tribunal decisions about registered health practitioners. 

When investigating a notification, the Board may refer a medical practitioner to a health panel hearing, or a performance and professional standards panel hearing. Under the National Law, panel hearings are not open to the public. Ahpra publishes a record of panel hearing decisions made since July 2010. Practitioners’ names are not published, consistent with the National Law. 

Summaries of tribunal and court cases are published on the Court and tribunal decisions page of the Ahpra website. The Board and Ahpra sometimes choose not to publish summaries, for example about cases involving practitioners with impairment.

In New South Wales and Queensland, different arrangements are in place. More information is available on Ahpra’s website on the Concerned about a health practitioner? page.

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More information

Please note: Practitioners are responsible for keeping up to date with the Board’s expectations about their professional obligations. The Board publishes standards, codes and guidelines as well as alerts in its newsletter. If you unsubscribe from this newsletter you are still required to keep up to date with information published on the Board’s website.

Comment on the Board newsletter is welcome and should be sent to newsletters@ahpra.gov.au.

For registration enquiries or contact detail changes, call the Ahpra customer service team on 1300 419 495 (from within Australia).

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