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ONCE upon a time, in a place long past, the colonial government of New South Wales needed to know which medical practitioners were qualified to give evidence at inquests. Thus, in 1838, the world’s first medical boards were created, in NSW and in Tasmania, which had split off from the original colony.
This month, after 182 years of successful self-regulation, these boards, and those in the other states and territories of Australia, have been replaced by a single national board.
Originally, medical boards were concerned with registration; then with action against rogues. More recently their role was extended to helping doctors with problems (mental and physical) to be well enough to attend to patients. Lastly, boards became involved with the quality of our practice, investigating alleged low standards and applying educational remedies.
As of 1 July, 2010, these functions become the responsibility of the National Medical Board, part of a new Australian Health Practitioner Regulation Agency. How might this new board handle these responsibilities?
1. Registration
This should be simple. The Australian Medical Council already maintains a database of practitioners in all states and territories. Ironing out duplications is straightforward, following the Mutual Recognition agreement between the jurisdictions many years ago.
2. Discipline
In a country the size of Australia, this could be awkward. The gathering of complainants, witnesses (of fact and expert) and of respondents, together with legal representatives, must surely be decentralised. Facilities and standards necessarily vary between cities, towns and countryside.
Fairness would demand that local circumstances be taken into account. Compliance with conditions on a doctor’s registration can only be checked locally – again a problem for a national body. This is already difficult for city-based boards in their own jurisdictions, especially regarding rural and remote areas.
3. Impairment
As with discipline, compliance with any conditions with respect to fitness to practice would need to be checked, again entailing local delegation.
4. Performance
Whereas the monitoring of conditions relating to impairment would be a periodic assessment by a specified treating doctor (usually a psychiatrist), monitoring of conditions relating to standards needs more consistency, if not, at times, a colleague looking over the doctor’s shoulder.
With the new Board starting its journey on 1 July, I cannot help but wonder how it is going to overcome these problems.
Posted: 5 July, 2010
Dr Peter Arnold is the former Deputy President, NSW Medical Board and Former Chairman of the AMA Federal Council and a non executive director with the Doctors’ Health Fund.
300 retired practitioners attended an AMA two day course in Sydney in July to enable them to retain limited registration under the NSW system. If these represent a fifth of retired practitioners in Australia, these retired doctors currently save Medicare over a quarter of a million dollars annually. (1500 doctors and family members averaging six visits a year for continuation prescriptions and referrals, at $35 a visit.) Although currently retired practitioners will still be allowed limited practice rights by the new board, this grandfather clause will not apply to those retiring after 30 June 2010. The new board will thus abolish this saving to the taxpayer, as well as being curiously expensive in its own right (85% increase in registration fees – for what?).
Two points:
1. National Registration will at least be of value for those doctors moving from one state to another. However there is little value to the vast majority of established medical practitioners and a definite disadvantage in that cost – and red tape – will be increased, as it always is when Federal government is involved.
2. Doctors who have retired due to age, but who are fit to continue practise, will be even more inconvenienced than the present unsatisfactory situation where they may prescribe for their families, but only if their continuing prescriptions are checked by their general practitioners every six months. A situation which has been imposed upon senior doctors and which I, personally, consider a disgrace.
Under the new regulations they will be deprived of even this unsatisfactory situation!
As a consultant physician, I do not intend to be de-registered by the new National Registration regulations when I eventually retire, but to maintain my continuing medical education and pay the extra fees in order to stay on the Medical Register as long as I can, just to allow myself to write prescriptions for my family!