Philip Morris: Saving a lost resource

MEDICAL careers, like the human life cycle, have a beginning, a middle and an end.

Following a prolonged gestation of training, practitioners move on to their discipline of choice where they provide clinical care to patients, education and training to junior colleagues, and administrative support to hospitals and other medical organisations over decades of hard work.

At some stage every doctor starts to think about slowing down, or contemplates full retirement.

But moving from full-time practice to full retirement in one step is not a good thing — it’s not good for the practitioner’s physical and mental health, and not good for the profession either. It is also government policy to encourage older workers and professionals to stay in the workforce longer, beyond current retirement age if possible.

Despite this encouragement for older professionals to remain active in their field, in the medical arena we have a situation that is hostile to older doctors. When medical practitioners retire they are no longer able to prescribe, refer or undertake any other form of “practice”.

The Australian Health Practitioner Regulation Agency (AHPRA) is currently looking into the definition of “practice”. The current definition is broad and covers “any activity in which a practitioner uses their professional knowledge”.

But does this mean older doctors can continue to use their accumulated medical knowledge, skills and wisdom for work such as teaching, examining, mentoring, tutoring, assisting with tribunals, and advising government, non-government, voluntary and private/business organisations on medical matters? Uncertainty prevails for many doctors who cease clinical practice and find themselves in this situation.

My solution to the current problem of how older doctors can remain registered is to develop a new category of medical registration — termed “senior active” — that could be based on the MBA’s limited registration in the public interest.

This senior active registration should have unlimited duration and allow doctors to remain on the register of medical practitioners. Doctors could participate in activities (either remunerated or as a volunteer) using their medical knowledge, skills or wisdom, outside the care of individual patients.

There is also an opportunity here to have a group of registered practitioners available to assist in times of local, state and national disasters, providing the community with a precious medical resource.

Senior active doctors could, without fee or reward, refer an individual to a fully registered medical practitioner and prescribe drugs in extenuating or emergency situations, including renewal of a prescription provided by a fully registered doctor within the previous 6 months.

To undertake this limited prescribing, they would have to have undertaken professional education activities on prescribing therapeutic substances in the previous 12 months.

Registrants over the age of 80 years should be required to undertake a compulsory annual medical check by a general practitioner.

They should also have the discretion to prescribe for themselves, or for their immediate family. This level of discretion is available to all doctors in fully registered medical practice despite the general advice from the AMA and medical boards not to do so except in emergency or extenuating circumstances.

To deny this discretion to senior active doctors would raise the question of age discrimination.

The success of this category will depend on the restrictiveness of the practice definition and how much it will cost.

If the total cost for the registration fee, indemnity insurance and professional education expenses was kept within reason (say, below $500 a year) then the category may appeal to senior doctors to maintain their registration after leaving full registration status and before moving to full retirement.

Professor Philip Morris is qualified in psychiatry and addiction medicine and has a private psychiatric and medicolegal practice on the Gold Coast. He is professor at the Faculty of Health Sciences and Medicine, Bond University.

Posted 28 November 2011

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