Doctors have welcomed a plan to impose health and competence checks on clinicians over the age of 70 to assure patient safety, despite reservations that it might be open to challenge on discrimination grounds.
The new regime, to be developed over the next 12 months, includes peer review of practitioners with multiple substantiated notifications against them and stronger requirements for continuing professional development.
But the reforms, announced by the Medical Board of Australia, are a step back from the prospect of a UK-style revalidation scheme that drew protests across the profession last year.
“We think this proposal gets it right,” AMA President Dr Michael Gannon told The Medical Republic.
“It’s roughly in line with the CPD requirements many specialties already have from their colleges, but more importantly it tidies up those areas where doctors don’t necessarily belong to a specific college and are not necessarily meeting (their) CPD requirements.”
Dr Gannon expressed relief that the expert group advising the MBA had spurned the British revalidation model, which he said consumed doctors’ time “without a scrap of evidence that it protects patients”.
“When we look at these issues we should not look narrowly at what doctors might think of as an impost,” he said.
“We have to think about the impost on the care of patients. If doctors are spending hours on studying for exams again or onerous requirement for professional development, that not only takes doctors away from patients but it adds to the cost of healthcare.”
He acknowledged that some doctors might bristle at the planned requirement to undergo a health check on reaching 70 and every three years thereafter.
“Though I can imagine some of our membership will be uncomfortable with the concept, we don’t think it is unreasonable. This is certainly a model we can work with and tinker around the edges.”
Presidents of medical colleges were presented with a 105-page report outlining the new measures at a meeting on Tuesday.
RACGP President Dr Bastian Seidel said the report vindicated the RACGP’s move this year to adopt the controversial CPD program known as Planned Learning and Need (PLAN).
“The implementation of PLAN was not an easy decision, but in hindsight, was the right decision,” Dr Seidel said.
“The MBA’s new framework does not go beyond the continuous professional development program currently followed by RACGP members.”
But Dr Seidel said the MBA’s plans for compulsory health checks required further explanation.
“The RACGP will continue to advocate strongly against any discriminatory profiling of GPs,” he said.
“Our members dedicate their lives to general practice and the Australian community and do not deserve to be subjected to any form of discriminatory screening.”
ACRRM President Dr Ruth Stewart said the college presidents generally agreed the proposals were “responsible” and in the interests of patients.
“I’m pleased at where the report has settled. I think if we do this right, we have an opportunity for doctors to assure themselves and their communities that they are practising safe and quality medicine,” she said.
Dr Stewart likened the compulsory health check requirement to older people being cleared by their doctors as competent to drive.
“One of the details we have to get absolutely right is to ensure that our practitioners who are 70 and older feel supported by their colleges rather than feel singled out and criticised,” she added.
MBA chair Dr Joanna Flynn and advisory group head Dr Liz Farmer had given assurances that there was a strong evidence base for a competence review at 70.
But there was as yet no validated tool to judge a doctor’s competence to practice, Dr Stewart noted.
ACRRM’s CPD already met the requirements outlined in the MBA report.
Dr Adam Coltzau, president of the Rural Doctors Association of Australia, said a proposed rule for closer scrutiny of doctors practising in isolation from their peers could be a burden on rural and remote practitioners.
He also said the aged-based health and competence checks needed to be backed up with evidence.
“The argument is going to be interesting,” he said. “If there is substantial evidence that practitioners over a certain age pose a threat, show us the evidence. It would be easier to accept.”
The MBA will commission clinical advice on a practical and effective health check for doctors aged 70 and over in the coming year.
In the first phase of the project, the board intends to seek access Medicare data for use in checking performance and outcomes, and will launch a pilot of “formal peer reviews” of doctors with a number of substantiated notifications.
It will also ask medical deans and employers to watch for early signs of poor professional behaviour in medical students and trainees.