• Chair’s message
• Board codes, guidelines and policies
• International medical graduates
• Intern update
• News and alerts
• Panel, court and tribunal decisions

Chair's message

Welcome to the first electronic edition of the Medical Board Update. This replaces both the twice-yearly hard copy Update and the Communiqué posted on the website after each meeting of the National Board. Each month we will bring issues relevant to doctors in Australia to your attention and report on what the Board has been doing. We will provide links to tribunal decisions about medical practitioners and will distribute important alerts.

A major current focus for the Board is to improve our performance in relation to notifications. In the last financial year, there were 4,709 notifications about medical practitioners, which related to 4.2 per cent of registered medical practitioners.

Other than in NSW (where the Health Care Complaints Commission receives all complaints), notifications are received and processed in the local AHPRA office. The local Medical Board committee, which has both practitioner and community members, decides whether or not the notification needs to be investigated and then decides what will follow from an investigation. These decisions are based on an assessment of the risk to public safety. When a notification raises a serious risk, the Board may decide to take immediate action to limit a practitioner’s registration as an interim step, pending the outcome of an investigation.

The Board recognises that it is very stressful for practitioners to be the subject of a notification. In most cases, the outcome is that the Board does not need to take any action, while a small proportion of notifications raise serious concerns. We are working closely with AHPRA to measure and monitor performance, to ensure that matters that do not meet the threshold for investigation are finalised as quickly as possible and that serious matters are investigated rigorously and concluded in reasonable timeframes.

Dr Joanna Flynn AM
Chair, Medical Board of Australia

Revised code of conduct, guidelines and a new policy

The Board has published:

• a revised version of Good medical practice: a code of conduct for doctors in Australia (Good medical practice)
• a revised version of Guidelines for mandatory notifications
• a revised version of Guidelines for advertising regulated health services, and
• a new Social media policy.

View the new documents at Codes, guidelines and policies.

The Board encourages medical practitioners to make sure they are familiar with these revised codes, guidelines and policies. They come into effect in mid-March 2014 and will be the standards the Board uses to assess concerns about the professional conduct, performance or health of registered medical practitioners. Doctors should also be aware of their legal obligations under the Health Practitioner Regulation National Law, as in force in each state and territory (the National Law), in relation to mandatory reporting and advertising.

Good medical practice applies only to registered medical practitioners. The other guidelines and the social media policy are common across all the 14 professions regulated in the National Registration and Accreditation Scheme (the National Scheme) and apply to all registered health practitioners.

The Board reviewed Good medical practice, the advertising guidelines and the mandatory notifications guidelines as part of a scheduled review three years into the National Scheme. These are the first set of revised documents to be released this year, with more to come later in 2014.

The Social media policy is new. It does not change the basic obligations that practitioners must meet, but explains how the obligations that already exist in the National Law and Good medical practice apply to social media. The basic principle is that the same expectations apply to your behaviour wherever it occurs – online or in person.

The Board consulted widely in late 2013 about draft versions of these documents. The revised guidelines reflect our experience of the first three years of the National Scheme. The revisions aim to make the guidelines clearer so it is easier for practitioners to understand their obligations, and for members of the community to understand what the Board expects of medical practitioners.

More information about the revised guidelines, Social media policy and revised Good medical practice is available on the Board’s website.

Response to concerns about the new social media policy

While the Medical Board of Australia’s new social media policy has prompted some lively debate, the reality is that it doesn’t set new requirements.

Social media changes the means of communication, not the Board’s expectations of medical practitioners.

In other words, the social media policy clarifies that practitioners’ existing regulatory responsibilities apply to social media as they do to traditional forms of communication. They are not new expectations. They are existing expectations that apply to new media.

The ban on testimonials has triggered a lot of social media debate. In fact, the ban comes from the Health Practitioner Regulation National Law (section 133), which specifically rules out testimonials. The Board didn’t make this up. It developed guidance (through the Advertising guidelines) to help make practitioners’ legal responsibilities clear. The social media policy applies these same responsibilities to new media.

Our legislators shaped the National Law, including the ban on testimonials, based on history, traditional forms of media and past trends in complaints. Whether it is still appropriate in the 21st century, when there are a whole series of conversations taking place online, with different levels of control over who says what about who, is another question altogether. If there is appetite for change, this debate should be channeled into the forthcoming three year review of the National Registration and Accreditation Scheme, which we expect will include opportunities for feedback about aspects of the Law. Practitioners active in social media who are concerned about the current legal framework should seek out opportunities to have their say.

In the meantime, as a regulator, the core role of the Board is to protect the public. Our focus is squarely on managing risk to patients.

Through the social media policy, the Board requires practitioners who are involved in social media to make sure they meet their regulatory responsibilities. These already exist in the Board’s code of conduct (Good medical practice (524 KB,PDF)), the advertising guidelines and now the social media policy.

Also, the policy doesn’t change the threshold for investigating concerns about a doctor’s conduct. It simply aims to make it clear what that threshold is.

The Board received nearly 5,000 complaints about medical practitioners last year. As a regulator, it will continue to focus on public safety and managing risk to patients. Part of the Board’s job is to make sure the standards it expects practitioners to meet are clear. In turn, the Board expects practitioners to take reasonable steps to meet them.

Social media will continue to evolve. The Board will keep thinking about both the opportunities and challenges of social media. We will continue to consult with the profession and the community as we grapple with these issues and look to international experience. The challenges of social media for regulation of health practitioners are not unique to Australia.

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Changes to registration pathways for international medical graduates

All international medical graduates (IMGs) who are not qualified for general or specialist registration must meet the requirements of one of the following pathways to be eligible for general or specialist registration:

• competent authority pathway
• standard pathway, or
• specialist pathway.

The Board reviewed the IMG assessment pathways and after wide-ranging consultation is making changes to the:

• competent authority pathway, and
• specialist pathway (specialist recognition and area of need).

The changes will be introduced on 1 July 2014. The changes aim to simplify and streamline the process for IMGs who are applying for registration under one of these pathways.

Competent authority pathway

The competent authority pathway applies to medical practitioners who are in one of the following six categories:

1. Successfully completed the Professional and Linguistic Assessments Board (PLAB) test since 1975, AND successfully completed the Foundation Year 1 or 12 months’ supervised training (internship equivalent) approved by the General Medical Council in the United Kingdom or another Australian Medical Council (AMC)-designated Competent Authority country.
2. Graduate of a medical course conducted by a medical school in the United Kingdom accredited by the General Medical Council, AND successful completion of the Foundation Year 1 or 12 months’ supervised training (internship equivalent) approved by the GMC in the United Kingdom or another AMC-designated Competent Authority country.
3. Successfully completed the licentiate examinations of the Medical Council of Canada (LMCC) since 1992.
4. Successfully completed the United States Medical Licensing Examination Step 1, Step 2 and Step 3 since 1992 AND successfully completed a minimum of two years of graduate medical education within a residency program accredited by the Accreditation Council of Graduate Medical Education.
5. Successfully completed the New Zealand Registration Examination AND successfully completed the required rotating internship (four runs accredited by the MCNZ).
6. Graduate of a medical school in Ireland accredited by the Medical Council of Ireland AND successful completion of an internship in Ireland (certificate of experience) or in another Competent Authority country approved by the Medical Council of Ireland.

The main changes to the competent authority pathway are summarised below.

• The path to general registration is streamlined so IMGs will be eligible to apply for provisional registration once they are deemed by the Board to be in the competent authority pathway. They will not be required to apply for limited registration.
• IMGs with provisional registration will be required to complete a period of supervised practice. After completing the period of supervised practice satisfactorily, they will be eligible for general registration.
• IMGs in this pathway will no longer be required to obtain the certificate of the AMC. Their dealings with the AMC will be restricted to applying for primary source verification.

These changes apply to IMGs who are granted registration after 1 July 2014. IMGs who are on the competent authority pathway and have been granted limited registration before 1 July 2014 will receive the AMC certificate and will continue to have limited registration.

Specialist pathway

This pathway is for specialist international medical graduates who wish to practise in a specialty in Australia. Specialist colleges evaluate the training, qualifications and experience of the IMG for comparability with an Australian-trained specialist.

There are two components associated with the specialist pathway:

• assessment for specialist recognition to enable individuals to be registered and practise as specialists, or
• assessment for suitability for a specific Area of Need position, which does not of itself lead to recognition as a specialist in Australia.

The AMC currently acts as a clearing house for applications for the specialist pathway.

From 1 July 2014:

• IMGs will apply directly to the specialist college for assessment of comparability and/or area of need. The AMC will no longer act as a clearing house for applications. IMGs will deal directly with the college that is assessing their application
• AHPRA, the AMC and the colleges will communicate more efficiently by using a secure portal that stores key information about applicants. This will include the results of primary source verification and the results of assessments. That will reduce the number of documents that applicants for registration have to provide to AHPRA
• the definitions of ‘substantially comparable’, ‘partially comparable’ and ‘not comparable’ have been reviewed and clarified, and
• clarification of the points at which fees can be charged by colleges have been defined.

The Board is working with the AMC and the specialist medical colleges to implement the changes to the specialist pathway.

The changes to the specialist pathway and the competent authority pathway will be introduced on 1 July 2014. The Board will keep stakeholders informed of progress in implementing the changes. Keep an eye on the website for regular updates.

More detailed information on the changes to the pathways can be found in the Board’s consultation document Consultation on proposed changes to the competent authority pathway and specialist pathway for international medical graduates, under Past consultations on the Board’s website.

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New national standards framework for intern training

There is a new national standards framework for intern training. This framework supports the Board’s approved registration standard, Granting general registration as a medical practitioner to Australian and New Zealand medical graduates on completion of intern training (the standard). The AMC developed the framework at the request of the Board.

The Board’s registration standard defines the supervised practice that interns are required to complete to be eligible for general registration. From 2014, this supervised practice must be accredited by an authority approved by the Board, against approved accreditation standards for intern training programs.

As part of the framework, on behalf of the Board, the AMC will review and accredit authorities that accredit intern training programs in each state and territory. These authorities are commonly known as postgraduate medical councils (PMCs). As this is a new process, the AMC is progressively accrediting each of the PMCs.

The following PMCs are approved by the Board to accredit intern training programs in their respective state or territory.

The Board has approved a range of documents developed by the AMC to support the framework. The documents detail the standards for intern training programs and provide guidance to interns and providers of intern training. The documents are available on the Board’s website under Accreditation and Interns. They can also be found on the AMC website.

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Minister appoints Queensland Medical Board

The Minister for Health in Queensland, Lawrence Springborg, has appointed members to the Queensland Board of the Medical Board of Australia.

The following members have been appointed to the Queensland Board of the Medical Board of Australia:

For doctors practising in Victoria – assessing prescription opioid misuse

The Department of Health in Victoria has released a document to help doctors in Victoria assess the risk of patients developing opioid misuse disorders. For more information, go to http://docs.health.vic.gov.au/docs/doc/Assessing-patients-when-considering-treatment-with-opioids 

New Termination of Pregnancy laws – Tasmania

The law on pregnancy terminations in Tasmania has changed. The changes came into effect on 12 February 2014. For more information, go to www.dhhs.tas.gov.au/pophealth/termination_of_pregnancy   

NHMRC releases resources on stem cell therapies

The NHMRC has released two resources on stem cell therapies: a quick guide for medical practitioners and frequently asked questions for patients. For more information, visit Guidelines>Publications on the NHMRC website.

Rescheduling of alprazolam

The Board published an article in the November 2013 edition of the Update that implied that alprazolam has been rescheduled as a Schedule 8 drug only in Victoria. The rescheduling of alprazolam applies nationally.

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Panel, court and tribunal decisions published online

AHPRA on behalf of the 14 National Boards publishes a record of panel, court and tribunal decisions about registered health practitioners. Summaries are published when there is clinical and educational value.

Court and tribunal decisions

Under the National Law, the Board must refer a matter about a registered medical practitioner or student to a tribunal if the Board reasonably believes that the practitioner has behaved in a way that constitutes professional misconduct; or the practitioner’s registration was improperly obtained because the Board was given false or misleading information. The Board must also refer the matter to a tribunal if a panel established by the Board requires the Board to do so.

Medical practitioners may also appeal certain decisions of the Board to a tribunal, or court.

AHPRA publishes summaries of selected tribunal or court cases from time to time. These can be sourced at Publications>Tribunal decisions on the AHPRA website. A full library of published hearing decisions from tribunals or courts relating to complaints and notifications made about health practitioners or students is available on the Austlii website.

Panel hearings

When investigating a notification, state and territory committees of the Medical Board of Australia 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. Summaries have been provided when there is educational and clinical value. These summaries are accessible from hyperlinks within the table. Practitioners' names are not published, consistent with the requirements of the National Law. This table does not include summaries of panel decisions made under previous legislation, even if these were held after July 2010.

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Contacting the Board

• The Medical Board of Australia and AHPRA can be contacted by phone on 1300 419 495.
• For more information, see the Medical Board of Australia website and the AHPRA website.
• Lodge an enquiry form through the website under Contact us at the bottom of every web page.
• Mail correspondence can be addressed to: Dr Joanna Flynn, Chair, Medical Board of Australia, GPO Box 9958, Melbourne, VIC 3001.

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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