This is an edited version of a conversation with Dr Anne Tonkin, Chair of the Medical Board of Australia, conducted on Tuesday 19 February 2019. You can listen to the full interview as a podcast, here.
InSight+: Congratulations on your appointment. You’ve been in the job 6 months. How’s it been? Are you settling in?
Dr Anne Tonkin: I’m having a very interesting and challenging time, but it is very fascinating. When I was first offered this appointment, my big thing was [that] I would really like us to be a little bit more outward facing. I’d like us to be understood a bit better, which is part of that. And so those are some of the things I’ve been talking about – making contact with the profession and the public, in a better way.
Part of that is also about reducing the fear factor, reducing the distress that notifications cause. I’ve had a notification myself … which didn’t come to anything, but just having it was very distressing. I’m not looking through rose-coloured glasses.
I’d like [notified doctors] to care but not be absolutely laid flat by it, not be devastated. Knowledge is power and if we can get more knowledge out [about] what we are trying to do and what we’re not trying to do, that will be extremely useful. That’s my overarching vision for the time that I’m in this position – trying to get us better understood.
I don’t expect us to be loved, but if we could get understood, that would make me very happy.
InSight+: What’s become clear to us is that there are a lot of doctors out there who have a [negative] view of the Medical Board and the Australian Health Practitioner Regulation Agency (AHPRA) generally, and of mandatory reporting, in particular. We’ve had a poll running for a couple of months now that’s got almost 3000 respondents and it’s sitting at about 60% of doctors who believe that they cannot seek treatment from a doctor for their mental health issues without putting their career in danger.
Dr Tonkin: I’m very concerned about that. We have our own information that says the same.
InSight+: Do you think people are not understanding the law? Is the law not written clearly enough or is there some kind of miscommunication going on?
Dr Tonkin: I think most people probably haven’t got around to reading it because it’s not exactly gripping reading. And the recent consideration in Queensland led to quite a bit of discussion about it and I think there’s a lot of fear and confusion.
I’m very concerned about people saying that they don’t think they can get help, because the Medical Board is not the slightest bit interested in hearing about anybody who has any kind of health issue that they are dealing with appropriately, and that doesn’t affect their practice. We don’t even want to know.
One of the things that [health] ministers are asking the Board to do is to be part of an education campaign. We’re already starting to negotiate with people like the Australian Medical Association and the medical defence organisations to get the information out there and have people less fearful. We don’t want anyone to be fearful of seeking any help they might need.
InSight+: What does this education program entail from your point of view?
Dr Tonkin: We are at the very early stages of that. It will be a matter of waiting until the national [mandatory reporting] law is amended, which is going through the process at the moment. We’ve started to talk to people in principle about whether they would be willing to be involved. [So far], everybody’s saying yes, because I think everybody’s seeing the same fear and misunderstanding.
It is very concerning if people need help and they’re not going to get help because of a fear of mandatory reporting, which is unfounded in terms of what it means. So, we need to get a message out about what it really means – who is liable to be reported and who isn’t.
The majority of doctors seeking any kind of medical attention do not need to be reported. They do not reach the threshold, which is a high threshold.
InSight+: Are you also aware of a perception among health professionals of both AHPRA and the Board as being the “bad guys”?
Dr Tonkin: We’ve done some research ourselves. The numbers of practitioners who actually said they didn’t trust the Board were pretty low.
For most people, the only interaction they have with us is at renewal of registration time. Unless they have a notification about them. And that’s when some people have experiences that they find very distressing, and we understand that as well.
We’re working very hard to try and improve that experience as much as possible. We’re doing some research on that. We’re getting interviews from those who’ve had notifications made about them. About 80% of them don’t have any regulatory action taken at all. Again, it’s a case of people fearing for their career in a situation where the chances of their career being in any danger is extremely low, unless it’s a particular kind of notification, like a sexual boundary transgression or something like that.
It is most likely they’ll have no further action taken because it will turn out that their practice was perfectly fine and there was an unfortunate complication, and that happens in medical practice.
But occasionally there may be someone who has a pattern of poor outcomes that we might deal with by asking them to do some extra training or some education courses. Then, they can return to practise. They might have conditions on their practice, but they go on practising while they’re up-skilled.
Our entire goal here is to protect the public while taking the least onerous possible action against the practitioner’s registration. We are constantly doing that balancing act.
There are occasions when we can do things that do make the public safer. Public perception of the Board, I hope, is that’s what our job is.
And I’d like the medical profession to understand that that’s our job, but also to feel that we’re at the same time protecting their profession from reputational damage caused by the very few who end up behaving in a way that’s not consistent with being a medical professional.
One of the things I’m very passionate about is trying to improve the experience that medical practitioners have when they are notified about, and to improve the experience that the notifier has.
One of the things that we are trying to do is to up-skill Board members and staff about communication. We’ve changed the format of our letters a lot in recent times, for example.
One of the other things that makes both the notifier and the practitioner very distressed sometimes is the length of time that the notifications process takes. We’ve taken steps to improve that, [including] getting a more national approach to dealing with notifications. We now have offices that have particular expertise in certain types of notifications.
We’ve a national committee for assessing [notifications when they come in], which has led to a big improvement in the timeliness, particularly of very low level notifications. When the notification comes in, it is seen by committee members within a week or two. Low level notifications, where there is no risk to the public, can be closed there and then within a couple of weeks.
It also picks up on the ones that are serious and need investigation. The committee can send them off for investigation right then instead of going through other steps that we used to go through that meant matters would sometimes not even get into investigation for 2 or 3 months. Now, there can be an investigation within a month of arrival if this needs to be.
That committee has been running for just over 6 months and we’re seeing a turnaround in the numbers of open notifications for the first time, which is terrific.
InSight+: Let’s talk about the proposed changes to the Code of Conduct. The public submission period is closed, and you’ve had about 800 submissions. What does the timeline look like?
Dr Tonkin: [The number of submissions] surprised us a little because we didn’t think that the changes were particularly large, and in fact, most of what we’ve done in the last draft is to rewrite some of the previous sets of guidelines to make them clearer.
There are a couple of areas where I think there’s been significant misunderstanding of what we meant, which means we haven’t written it clearly enough. We’re looking to sort that out – we’ve got a working party on that and it’s nearly ready to come back to the Board … in the next couple of months. Then it will go out again for a targeted consultation round just to make sure that what we have written is not as open to misunderstanding as what’s there currently.
InSight+: Tell us about the National Training Survey.
Dr Tonkin: That’s a big piece of work for us this year. It’s modelled on the survey that the General Medical Council has been doing for 15 years or so now. It arose from the review of the intern year and some concerns about bullying.
We laid a bit of groundwork last year by adding a question for people to answer, which was, “Are you a doctor-in-training?” In the registration period in August and September, if they are a doctor-in-training, they will be given the option, not compulsory, of clicking the link to this survey, which will then ask them about their experience during their training.
The idea is to understand the quality of medical training better and to work with the Colleges and the other training bodies to try and improve medical training if it’s needed.
Our view is predominantly about the patient safety aspects – we know that patient safety is threatened when there is a poor culture in the workplace – bullying in the workplace, unacceptable behaviour and poor supervision. All of those things add to trainee stress, and patient safety is threatened when trainees are feeling stressed.
We’re hoping [the survey] will give both us and all the other stakeholders, including the employers and the Colleges, information about how training is going. If we can get a good response rate, we can get some solid data that will help employers and colleges and other training bodies to improve things where it’s needed.
I suspect the majority of training will be spot on. There might be some little pockets of difficulty that need to be dealt with. Knowledge is power and if we find that, then it’s possible for someone to do something about it.
We’re excited about the National Training Survey and we’re looking forward to seeing it roll out successfully the first time. That’ll be the big test.
InSight+: Where are things at with the Professional Performance Framework?
Dr Tonkin: That’s the other thing that’s big for us that’s going to take a while.
[As you know], it’s made up of five pillars. Some of them are moving ahead a bit faster than others as you might expect.
There’s been a working party for the Strengthening of Continuing Professional Development (CPD) pillar, which has produced a report which is going to the Board at our next meeting. A revision of the CPD registration standard has been drafted … and will come back to the Board in March.
The Active Assurance of Safe Practice pillar has the two elements of the age-related health check and the professional isolation, and we’re still sorting through how they might best be done. And we’ll be getting some external advice on how we do those things.
InSight+: Thank you so much, Anne. We very much appreciate your time.
Dr Tonkin: My pleasure, and thank you for the conversation.