Despite unanswered questions about tougher rules for older practitioners, doctors have responded with relief to the Medical Board’s long-awaited plan to assure patient safety.
The board announced it would impose health and competence checks on clinicians over 70, while acknowledging that the step might be open to challenge on discrimination grounds.
The new rules will include peer reviews of practitioners with multiple substantiated complaints against them and stronger requirements for continuing professional development for all health practitioners.
But the reforms, to be worked out in detail over the next 12 months, are a big step back from the prospect of a UK-style revalidation scheme for doctors that sparked a backlash 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.”
Under the new rules, all doctors must have a CPD home base aligned with their scope of practice. Requirements still need to be worked out for prevocational doctors and those without affiliation to a college.
“We need to look in greater detail at what happens to doctors that don’t have a traditional career path,” Dr Gannon said.
Another concern was access to records, and issues of privacy, fairness and transparency around mandatory health checks for impaired doctors and doctors aged over 70.
“We are concerned at the prospect that a medical defence organisation might have direct communication with the board. We need to see greater detail on that,” Dr Gannon said.
Dr Gannon acknowledged some doctors might bristle at the new 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.”
The framework was a lot better than UK model, which drained doctors’ time without any proof of better patient outcomes, and vastly preferable to a mandatory retirement age, he said.
ACRRM President Dr Ruth Stewart said medical college presidents generally agreed that the proposals were “responsible”.
“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.
She likened the compulsory health check to older people being cleared as competent to drive, but noted that as yet there was no validated tool to judge a doctor’s competence.
The board will commission clinical advice on a practical and effective health check for doctors aged 70 and over in the coming year.
“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,” Dr Stewart said. “Most doctors who continue working do so because they feel confident. It’s not that they will have to sit an exam. They have a medical assessment and continuing CPD in which they reflect on their practice.”
The board has also formally put medical schools and employers of junior doctors on notice to instil habits of reflective practice and professionalism early on.
Australia’s largest medical school, at the University of Queensland, says these aspects of training are already “overt” in the curriculum.
“We expect a good doctor to be honest, we expect them to be compassionate, we expect them to be humble and seeking out new knowledge,” UQ head of medical ethics, law and professional practice, Dr Sarah Winch, said.
“We teach behaviours related to professionalism all the way through the course. It’s really about providing very clear expectations and helping them meet those expectations.
“If we feel they do not have the character and temperament to be a modern doctor in Australia, and we have enough information to demonstrate that, they will be removed from the program.”
The board’s stronger CPD requirements are not expected to impose extra burdens on GP members of ACRRM and the RACGP.
RACGP President Dr Bastian Seidel said the board’s stance vindicated the College’s move to adopt the CPD program known as Planned Learning and Need (PLAN), which requires doctors to declare areas of practice where they need to improve.
He said the College would continue to advocate against any discriminatory profiling of GPs. “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,” Dr Seidel said.