Australian doctors are kept on a short leash. I recently renewed my registration with the Australian Health Practitioner Regulation Agency (AHPRA). This annual ritual is always interesting.
Like thousands of other doctors, I first had to fill out an online questionnaire. As usual, AHPRA wanted to know if I had a physical or mental impairment, disability, condition or disorder – including substance abuse or dependence – that would detrimentally affect my capacity to work as a doctor. They reminded me I’m required by law to declare any impairments.
I had to answer questions about my criminal record, compliance with the law, continuous professional development, indemnity insurance, work history and even immigration status. If I did not give the required information, I could lose my registration.
Finally, I had to make a declaration that I spoke nothing but the truth, and I dutifully transferred the required $724 into AHPRA’s bank account.
High professional standards
The yearly AHPRA registration procedure symbolises the way doctors are controlled in Australia. Contrary to common belief, we’re allowed little freedom.
Before we can prescribe medications, we have to ring up Medicare to get approval. Our prescribing habits are being watched. We are audited randomly to make sure our billing practices are not out of line with our peers. We may be prosecuted by the PSR if we deviate from the average. In most states, doctors have to report colleagues who underperform.
At the same time, professional medical standards in Australia are high. Take the accreditation standards of the Royal Australian College of General Practitioners, or the CPD requirements. Both quality assurance programs have become more robust over the years and are continuously being reviewed and improved by the College.
The RACGP ‘Standards for General Practice’ ensure safe and high quality care, and are used by over 80 per cent of Australian general practices for accreditation. The QI&CPD Program recognises ongoing education to improve the quality of everyday clinical practice by promoting the development and maintenance of General Practice skills and lifelong learning.
Is there a problem?
So why is there still talk about revalidation of doctors? Is the public concerned about the quality of Australian doctors? It appears that the opposite is the case.
The national AMA patient survey indicated that GPs are considered by the public to be trustworthy, knowledgeable and experienced. A large patient satisfaction survey endorsed by the RACGP found there was a very high level of satisfaction with General Practice in Australia.
Another study published in the MJA also showed that patients reported high levels of satisfaction with GP care, and for many years Australian doctors have been in the top three most trusted professions in the annual Roy Morgan research.
Based on numbers from Canada, AHPRA estimates that 1.5 per cent of Australian medical practitioners are performing ‘unsatisfactorily’. I’m not sure Canadian figures can be applied to Australia, but 1.5 per cent of unsatisfactory performers in any group is low. It appears that any potential problem lies with a significantly small minority of doctors.
Carpet-bombing the profession
There are many revalidation models – from strengthening CPD to targeting those at high risk of complaints, to the full- bore version rolled out in the UK. But if the AHPRA tries to identify substandard doctors, carpet-bombing the whole profession is problematic.
Dr Steve Wilson, Chair of the AMA (WA) Council of General Practice, questioned in the Medicus magazine whether revalidation would address those who failed to practise to agreed levels. And if it did, he asked, would that be a sign of impairment or does it reflect personal style, or lack of time, training, experience or adequate remuneration? Excellent questions indeed.
Competency checks of doctors may sound appealing to the public. I’m sure some politicians will love the rhetoric. But simply copying the UK’s revalidation system would be a big mistake.
About 5,000 doctors a year are considering leaving the UK, and many come to Australia. Bureaucracy is one reason they emigrate. The last thing we need in Australia is more regulation, red tape and stressed-out doctors.
Existing quality systems
In recent years, our healthcare system has seen enough unsuccessful concepts not supported by evidence. Think for example about the super clinics program and the accompanying cost blowouts, delays and disappointing results. It will be easier and cheaper to build on existing quality assurance systems.
This article has previously been published in Medicus, the AMA(WA) magazine.