Patterns of physician retirement and pre-retirement activity: a population-based cohort study [Research]

BACKGROUND:

Knowing when physicians retire and how they practise in the pre-retirement years is important information for health human resource planning. We identified patterns of retirement for physicians in British Columbia and the determinants of when and how physicians retire.

METHODS:

For this population-based retrospective cohort study, we used administrative data to examine activity levels and to identify retirements among BC’s practising physicians. We included all physicians who were at least 50 years of age as of March 2006 and who had received payments for clinical services in at least 1 year between 2005/06 and 2011/12. We defined retirement as a permanent drop in monthly payments to less than $1667/month ($20 000/yr). We examined the patterns and timing of retirement by age, sex, specialty and location using linear and logistic regression models.

RESULTS:

Of the 4572 physicians who met the inclusion criteria, 1717 (37.6%) retired during the study period. The average age at retirement was 65.1 (standard deviation 7.8) years. Controlling for other demographic and practice characteristics, we found that women and physicians working in rural areas retired earlier, by 4.1 (95% confidence interval [CI] –4.9 to –3.2) years and 2.3 (95% CI –3.4 to –1.1) years, respectively. We found no difference in retirement age by specialty. We identified 4 patterns of pre-retirement activity: slow decline, rapid decline, maintenance and increasing activity. About 40% of physicians (440/1107) reduced their activity levels by at least 10% in the 3 years preceding retirement.

INTERPRETATION:

During the study period, physicians in BC — particularly women and those in rural areas — retired earlier than indicated by licensure and survey data. Many physicians reduced their practice activity in the pre-retirement years. These trends indicate that forecasts relying on licensure “head counts” are likely overestimating current and future physician supply.

Payment incentives for community-based psychiatric care in Ontario, Canada [Research]

BACKGROUND:

In September 2011, the government of Ontario implemented payment incentives to encourage the delivery of community-based psychiatric care to patients after discharge from a psychiatric hospital admission and to those with a recent suicide attempt. We evaluated whether these incentives affected supply of psychiatric services and access to care.

METHODS:

We used administrative data to capture monthly observations for all psychiatrists who practised in Ontario between September 2009 and August 2014. We conducted interrupted time-series analyses of psychiatrist-level and patient-level data to evaluate whether the incentives affected the quantity of eligible outpatient services delivered and the likelihood of receiving follow-up care.

RESULTS:

Among 1921 psychiatrists evaluated, implementation of the incentive payments was not associated with increased provision of follow-up visits after discharge from a psychiatric hospital admission (mean change in visits per month per psychiatrist 0.0099, 95% confidence interval [CI] –0.0989 to 0.1206; change in trend 0.0032, 95% CI –0.0035 to 0.0095) or after a suicide attempt (mean change –0.0910, 95% CI –0.1885 to 0.0026; change in trend 0.0102, 95% CI 0.0045 to 0.0159). There was also no change in the probability that patients received follow-up care after discharge (change in level –0.0079, 95% CI –0.0223 to 0.0061; change in trend 0.0007, 95% CI –0.0003 to 0.0016) or after a suicide attempt (change in level 0.0074, 95% CI –0.0094 to 0.0366; change in trend 0.0006, 95% CI –0.0007 to 0.0022).

INTERPRETATION:

Our results suggest that implementation of the incentives did not increase access to follow-up care for patients after discharge from a psychiatric hospital admission or after a suicide attempt, and the incentives had no effect on supply of psychiatric services. Further research to guide design and implementation of more effective incentives is warranted.

Coordinated approach needed to improve Indigenous ear health

Ear health is the focus of the 2017 AMA Indigenous Health Report Card, with doctors calling on all Governments to works towards ending chronic otitis media.

Releasing the Report Card in Canberra on November 29, AMA President Dr Michael Gannon challenged the Federal Government and those of the States and Territories to work with health experts and Indigenous communities to put an end to the scourge of poor ear health affecting Aboriginal and Torres Strait Islanders.

The Report’s focus on ear health was part of the AMA’s step by step strategy to create awareness in the community and among political leaders of the unique health problems that have been eradicated in many parts of the world, but which still afflict Indigenous Australians.

“It is a tragedy that in 21^st century Australia, poor ear health, especially chronic otitis media, is still condemning Indigenous people to a life sentence of hearing problems – even deafness,” Dr Gannon said.

“Chronic otitis media is a disease of poverty, linked to poorer social determinants of health including unhygienic, overcrowded conditions, and an absence of health services.

“It should not be occurring here in Australia, one of the world’s richest nations. It is preventable.

“Otitis media is caused when fluid builds up in the middle ear cavity and becomes infected.

“While the condition lasts, mild or moderate hearing loss is experienced. If left untreated, it can lead to permanent hearing loss.”

Dr Gannon said that for most non-Indigenous Australian children, otitis media is readily treated, but for many Aboriginal and Torres Strait Islander children, it is not.

Estimates show that an average Indigenous child will endure middle ear infections and associated hearing loss for at least 32 months, from age two to 20 years, compared with just three months for a non-Indigenous child.

The Report Card, A National Strategic Approach to Ending Chronic Otitis Media and its Life Long Impacts in Indigenous Communities, was launched in Parliament House by Indigenous Health Minister Ken Wyatt

Mr Wyatt commended the AMA on its 2017 Report Card.

Over the past 15 years, he said, the AMA’s annual Report Card on Indigenous Health has highlighted health priorities in Australia’s Aboriginal peoples and communities.

“Reports can be daunting and they can be challenging,” the Minister said.

“But above all, they can be inspiring.”

Mr Wyatt said it was a tragedy that the most common of ear infections and afflictions were almost entirely preventable.

Yet left untreated in Indigenous children, they had lifelong effects on education, employment and well-being.

“It’s not somebody else’s responsibility. It’s the responsibility of all of us,” he said.

“Hearing is fundamental.”

Shadow Indigenous Health Minister Warren Snowdon also commended the AMA on its report.

He said the Government and the Opposition worked collaboratively on Indigenous health issues.

“We’re not interested in making this a point of political difference, we’re interested in making it a national priority,” he said.

Green’s Indigenous Health spokeswoman Senator Rachel Siewert welcomed the Report and stressed the importance of addressing Indigenous health issues.

Australia’s first Indigenous surgeon, ear, nose and throat specialist Dr Kelvin Kong, who is also the Chair of the Australian Society of Otolaryngology Head and Neck Surgery’s Aboriginal Health Subcommittee, received the report with enthusiasm.

He said cross-party support on this issue had been “phenomenal”.

Dr Gannon said the AMA wants a national, systematic approach to closing the gap in the rates of chronic otitis media between Indigenous and non-Indigenous infants and children in Australia.

The Report calls on Governments to act on three core recommendations: namely, that a coordinated national strategic response to chronic otitis media be developed by a National Indigenous Hearing Health Taskforce under Indigenous leadership for the Council of Australian Governments (COAG); that the wider impacts of otitis media-related developmental impacts and hearing loss, including on a range of areas of Indigenous disadvantage such as through the funding of research as required are addressed; and that attention of governments be re-directed to the recommendations of the AMA’s 2015 Indigenous Health Report Card, which called for an integrated approach to reducing Indigenous imprisonment rates by addressing underlying causal health issues.

“We urgently need a coordinated national response to the lasting, disabling effects and social impacts of chronic otitis media in the Indigenous adult population,” Dr Gannon said.

The AMA Indigenous Health Report Card 2017 A National Strategic Approach to Ending Chronic Otitis Media and its Life Long Impacts in Indigenous Communities can be found at article/2017-ama-report-card-indigenous-health-national-strategic-approach-ending-chronic-otitis

CHRIS JOHNSON

AMA Fees List finalised

The AMA has enhanced a key member benefit, with the launch of the AMA Fees List online in October. The new website has replaced the previous book and CD-ROM formats, making setting medical fees faster and more user friendly than ever before.

The new Fees List includes the annual 1 November 2017 indexation rates.

Since 1973, the Fees List has been a critical aid for AMA members by providing an important reference guide on medical fees. The Fees List is an original work owned and administered by the AMA Secretariat.

In moving online this year, the Fees List has been enhanced with number of features in to make referencing AMA Fees fast and easy for any medical discipline. This includes:

Interactive dashboard to find, search and save AMA fees
Search function that links directly to AMA and MBS item descriptions
Customised user profile with options to save, download or print favourite items
Fee calculator tools including a new Anaesthesia fee calculator
Ability to print parts of, or full PDFs of the Fees List
Online tutorials and help tools
Mobile and tablet compatible
Full PDF and CSV downloads.

The move to the online format has also enabled the Fees List to be updated throughout the year, as ongoing changes are made to the MBS as a result of the MBS Reviews.

All financial AMA members will continue have free, unlimited access to the Fees List online and its many features. We have also introduced new purchasing options and licensing arrangements for select third party groups, such as hospitals, workers compensation agencies and health insurers who reference the AMA fees or provide assistance to AMA members with their billing.

The Fees List is primarily an AMA member benefit and whilst the AMA’s aim is to provide guidance on fair and reasonable medical fees, the AMA does not permit the unauthorised use of the Fees List by billing agencies and software companies for clients who have not purchased the list themselves – due to the risk of copyright infringement of AMA intellectual property.

Of course, many members use these agencies to support their billing operations, which may require providing the AMA rates to these services for their individual billing purposes.

The new Fees List website has been launched at a time when medical fees are under increasing medical and mainstream scrutiny. Medical practitioners are currently challenged with setting appropriate medical fees, amidst the backdrop of a frozen Medicare schedule. The result is that the MBS has not kept pace with the realistic costs of running a viable, quality practice.

The AMA encourages medical practitioners to use their own judgement to charge an appropriate fee for a medical service. Medical practitioners should satisfy themselves in each individual case as to a fair and reasonable fee, having regard to their own practice cost experience and the particular circumstances of the case and the patient.

More information on how the AMA Fees List can assist in setting, licensing and Terms of Use can be found on the Fees List website feeslist.ama.com.au

The next Fees List update is scheduled for 1 December and will include the 1 November MBS changes.

For login assistance please contact Member Services on memberservices@ama.com.au or 1300 133 655. For all other queries, please contact feeslist@ama.com.au

Eliisa Fok
Policy Adviser, Medical Practice

Thunderstorm asthma

BY DR RICHARD KIDD, CHAIR, AMA COUNCIL OF GENERAL PRACTICE

With then end of the year fast approaching, there are many joys that this time of year brings, but also many hazards. One such hazard is increased risk of thunderstorm asthma. It is now just over a year since the disastrous thunderstorm in Victoria that triggered a mass asthma emergency, with 8,500 people requiring hospital care and ten sadly losing their lives.

While Victorian hospitals featured prominently in the Victorian response, we also know that many patients accessed GP care and advice, including through after hours GP services.

Research is being conducted to better understand why epidemic thunderstorm asthma events occur. It is believed that grass pollens swept up into the clouds as a storm forms, absorb moisture and then burst open filling the air with small allergen particles. Unlike the larger grass pollen grains that cause hay fever, these particles are small enough to be drawn deep into the lungs. The irritation caused resulting in swelling, narrowing and additional production of mucus in the small airways of the lung, making it very difficult to breath.

Symptoms are quick to come on and typically involve wheezing, chest tightness and coughing, much like asthma.

As GPs, it important to be aware that it is not just people with asthma or a history of asthma that are susceptible to a thunderstorm asthma event. Anyone who suffers seasonal hay fever is also at risk. It is important that our at-risk patients understand this and know how to minimise their risks and manage any symptoms if they experience epidemic thunderstorm asthma.

Thunderstorm asthma is now recognised as a serious health threat and over the last year a range of resources have been made available to GPs to assist them in preparing their patients for the grass pollen season and any epidemic thunderstorm asthma event.

GPs should make sure they are up to date with the recommendations in the Australian Asthma Handbook and can undertake the free NPS Medicinewise Clinical E-Audit Asthma Management – supporting patients to achieve good control.This tool will help you improve the individual management of your patients by identifying risk factors, reviewing asthma control, adjusting management and reinforcing the benefits of maintaining an up-to-date written asthma action plan.

The National Asthma Council Australia has also made available a range of resources for GPs and other healthcare professionals in the event of another thunderstorm asthma event, which can be accessed here. These include information papers on epidemic thunderstorm asthma and managing allergic rhinitis in people with asthma and advice on preventative treatment.

In addition, the Asthma Australia website also contains general information about asthma which may be of use to GPs, including how to prepare for and respond to an asthma emergency. They also have specific resources for health professionals.

The key is ensuring at-risk patients understand the risks, know how to reduce them, and have an action plan for responding to symptoms.

This will be my last column for 2017, with the year seeming to go very quickly due to the never-ending advocacy of the AMA on GP issues. On behalf of the Council of General Practice I will take this opportunity to wish you all a safe and happy time with family and friends over the holidays.

Rural health in retrospect

BY DR SANDRA HIROWATARI, CHAIR, AMA COUNCIL OF RURAL DOCTORS

As the second Chair of AMACRD, I feel that despite being a relatively new group within the AMA, we have much to be proud of. So, as 2017 turns into 2018, I look at the circumstances that surrounded us, and am glad to note that we have worked hard, we have little victories we can take credit for.

So, Rural Doctors, I invite you to commemorate all our work in the year 2017, but also to note the challenges that lay ahead.

First off, I want to address the slow internet in the Outback. We are getting attention concerning this slowly (but steadily) and have advocated consistently for improvements.

NBN Co attended an AMACRD meeting at the time of the rollout of Skymuster II and had a good opportunity to hear our stories. We advocated to end the data drought by increasing bandwidth, reducing the cost per gb to make our data needs more affordable. We know that NBNCo has now announced larger satellite data allowances and intends giving medical practice ‘public interest premises’ status, which should improve data allowances and speed even further.
We made a submission to the Productivity Commission for the Telecommunications Universal Service Obligation, some of which we were pleased to see was included in their Final Report
Council members appeared before the Joint Standing Committee on the NBN, making a case for improved access to superfast broadband by describing in vivid stories what internet is like for us. I am told the stories were received with amazement.

Workforce Distribution continues to be an issue. Despite the influx of new medical graduates, there are still unfilled workforce needs in rural Australia. The concept of maldistribution is on the minds of everyone who is trying to solve this problem.

AMA has been invited to the Distribution Workforce Working Group. This group will meet frequently to advise the Minister of Health and the Rural Stakeholders Forum with recommendations.
We have also updated the AMA Rural Workforce Initiatives Position Statement to reflect the current state of our workforce and to offer solutions: new wet behind the ears medical graduates, bewildered overworked International Medical Graduates (IMGs) feeling unappreciated, rural health still far behind but eager to catch up.
The Government has provided funding of up to $93.8 million from 2015-16 to 2018-19 to implement three components to support the rural pipeline that included: Regional Hubs; Rural Junior Doctor Training Fund; and Specialist Training Programme.

Infrastructure is an area where we have had some wins, but we cannot afford to relax on this front. Hospital, clinics and toilets all need walls, doors and privacy.

Following AMA advocacy, the Government, as part of the 2016/17 Federal Budget, announced a redesign of the Rural and Remote Teaching Infrastructure Grants (RRTIGP) to create a more streamlined Rural General Practice Grants Program (RGPGP) which intends to improve uptake. AMACRD provided input to inform the Department of Health revision of the RRTIGP. The AMA will push for continued infrastructure grant funding.
Closure of services in hospitals, especially maternity services is the trend. However there are some “wins” in Queensland with their Rural Generalist program bolstering rural obstetrics.

In the past, Rural Health has been pushed into the background, but we are beginning to see it given some attention by the Government.

Recently at an international rural medical conference I was eavesdropping on North American attendees. They were impressed with the focus that Australia has on rural health. To quote, “They think rural health is so important they have a Federal Minister for Rural Health!”
Now we have even gone a bigger step forward. We have a National Rural Health Commissioner, Professor Paul Worley. That should impress the International Rural community. It took an act of parliament to create this arms-length Commissioner separate from the governing bodies and he is one of us. We will have an advocate, speaking on our behalf. He will be rolling out a national Rural Generalist program and the AMA is keen to work with him.

The vexed issue of Bonded Placements has yet to be resolved, but we are seeing some developments here.

The Government is looking at potentially reforming Return of Service (RoS) obligations on doctors working in bonded placements. This issue will continue to be developed into the new year as well. AMA is in discussions concerning this.
We need to care for our young, as they are the next generation of doctors. If they are treated like prisoners they will rarely return voluntarily to their former jail cells.

Regarding 2018, AMACRD has additional areas it will be vigilant on including (but certainly not limited to) the following:

Support for IMGs and doctors who are struggling with Australian Medical Council and Fellowship exams
Monitor the development of the National Rural Generalist Pathway
Provide input to Health care Homes, Practice Incentives Program redesign, and Medicare Benefits Schedule Reforms
Invigilate the application of the Modified Monash Model for Rural Workforce Incentive programs
Support our new Rural Health Commissioner
Rural Aged Care
Foster team work amongst Rural health care providers both medical and allied health
Monitor the new Rural Junior Doctor Innovation Fund (a tweak on the former Prevocational GP Placement Program (PGPPP)) to see 60 Full time equivalents by 2019.

Although some of these discussions may be uncomfortable, it is essential that we keep rural health in the spotlight. I look forward to continuing to make advancements and am optimistic about AMACRD achieving more victories in 2018.

@drshirowatari

MBS Reviews – A long way to go, and a lot of improvement needed

BY DR ANDREW MULCAHY CHAIR, MEDICAL PRACTICE COMMITTEE

Members will recall that the AMA cautiously welcomed the MBS reviews in 2015, noting it was a far-reaching exercise with an ambitious two-year timeline.

The AMA’s support for the MBS reviews has always been contingent on the review being clinician-led and having direct and early involvement of the specialist colleges, associations and societies (CAS). The AMA has called for the review to be fully transparent from decision making through to implementation, and be underpinned by a scientific approach. There must also be scope to add new items to achieve the overall aim of ‘modernising’ the MBS.

In March, the AMA entered into a compact agreement with the Government for a shared vision for Australia’s health system. We committed to support in principle the ongoing operation of the MBS Review Taskforce, including a transparent, consultative clinician-led approach to high-value care and future-proofing the system. During that time the Government extended the review another three years to 2020.

Under the compact, the AMA is committed to work with the Department of Health to deliver on agreed recommendations arising from the MBS Review in conjunction with the relevant sectors. The AMA will continue to identify areas to improve the review process and recommendations.

The AMA’s approach to the MBS review has always been to defer recommendations relating to specialty items to the relevant CAS groups, and comment on the broader policy.

Now two years into the review, the AMA is continuing to press the Government to ensure that reviews remain more than just a cost-cutting exercise, or a mechanism to meddle with the scope of clinical decision making.

In this context, the AMA reviews concerning recommendations against a set of key principles to determine if a response to the Taskforce is necessary. This work is undertaken through stakeholder consultation with an AMA Working Group drawing from the broader membership, and the Medical Practice Committee. AMA also facilitates an annual CAS meeting for stakeholders to air concerns and receive information as the reviews progress.

Based on these feedback mechanisms, the AMA has responded to every single MBS review consultation – raising issues from across our membership, while stressing where systematic improvements need to be made. The AMA Secretariat and the President have done this through direct representations with the Health Minister, the Department of Health and in writing to the Chair of MBS Review Taskforce.

In our latest submission to the MBS Review Chair, the AMA highlighted a number clear deficiencies and significant variations in the process adopted by the MBS Review Taskforce and the Clinical Committees.

Noting the commitment made by the profession to sit on the Clinical Committees and Working Groups, the AMA has continued to stress that there must remain absolute transparency of the review process.

In particular: where a decision is being made in contradiction to the advice of the profession, there should be clear evidence and data to support such a decision.

We also called for early engagement of CAS on each of the Clinical Committees to ensure recommendations are practical and consistent. We have called for complete transparency, starting with how Clinical Committee members are selected and details of the Committees’ scope of work. Finally, the AMA has strongly recommended the Clinical Committees engage early with other Department areas including the Medicare Compliance and Professional Services Review to ensure that any changes to the schedule are practical for clinicians and do not result in sub-optimal care for patients. We all know a poorly worded MBS item can set up a practitioner to fail.

What we don’t want to see is a confusing MBS schedule, with medical practitioners as scapegoats.

With more than half the Clinical Committees yet to be established, there is still a long way to go. The next round of public consultations is expected to occur in February, 2018, commencing with the anaesthesia and oncology reports. The AMA continues to monitor with interest, and encourages the profession and the CAS to engage in the consultation and review process early. The full schedule of MBS reviews can be found on the Department of Health website: http://www.health.gov.au/internet/main/publishing.nsf/content/MBSR-about

In the meantime, the AMA has and will continue to hold up our end of the compact with a commitment to a stronger MBS review. Government must ensure the Review does the same through a significant improvement in the way they conduct it.

The road ahead for 2018

BY DR ROD McRAE, CHAIR, AMA COUNCIL OF PUBLIC HOSPITAL DOCTORS

Another calendar year has flown. CPHD meets regularly to make sure AMA’s positions are informed by those with a Specialist qualification and choosing to self-identify as public hospital doctors. This embraces the Specialist employed experience and the continuing quest for continuous public hospital medical quality and general systems improvement. We have an influencing position that is enhanced by more members taking opportunity to solidify CPHD’s base and keep us rich with progressive ideas. Industrial negotiations for employed medical practitioners are currently underway in several jurisdictions, many of which have been impacted by the federal government’s alteration of previously understood arrangements related to salary packaging. It will be of acute interest to observe how these negotiations are managed, as most have mandated elections from the time of my writing to October 2018.

COAG – Public Hospital funding Agreement

In July 2017, the States and Commonwealth executed a health care funding Agreement out to 2020. It laudably touts incentives aimed to reduce avoidable sentinel events, hospital acquired complications and avoidable readmissions. However, if a State does not achieve an arbitrary benchmark, the otherwise locked in 45 per cent of their public hospital funding could be at risk (including a slice of an additional $2.9 billion of capped services growth funding).

There becomes a risk that any public hospital not adequately meeting its risk improvement targets, irrespective of cause, will then bear funding cuts, yet still be required to meet the defined Agreement imperatives (thus a potentially downward spiral of ‘doing more with less’). Such a hospital would be incentivised to rapidly make change in the hope of reducing its funding loss. Public hospitals may insist members work unsociable hours (for alleged quality & efficiency reasons), roll-out an unmanaged expansion of private practice arrangements (to cover funding shortfalls) and redirect Doctor’s clinical support time to the design of new systems (all to avoid the penalties). CPHD will work on these and a host other concerns that require our reasoned and measured response. In 2018, CPHD will monitor against such potentially perverse outcomes that may arise from the underpinning by an ultimately penalty-based regime, let alone the potential for cherry-picking.

Private Practice

For this health care funding agreement round, the Commonwealth seems to have flagged its willingness to consider change to the arrangements applying to private patients admitted to public hospitals. As discussed in October, there are good reasons why CPHD is concerned about any attempt to substantially reform existing arrangements, including availability of specialist clinical skills & equipment, supplementation of public hospital income and breadth of case mix available for optimum teaching, training and research.

CPHD recognises and supports the long-standing rights of public hospital patients who elect to receive services as a private patient, but appreciates there does need to be balance. It is a no-brainer that clinical need, not private/public status, must be the determinant for patient prioritisation and that the patient must be free to make informed choice without unfair inducements or undue pressure to convert to private insurance. Equally, Doctors must be assured of their right to provide care without undue pressure to encourage conversion from public status. CPHD will be at the vanguard of any mooted change agenda.

Personal Safety

In my August Australian Medicine piece I expressed how I am regularly horrified at the experiences of violence in our community and our workplaces. Therefore, CPHD motives are obvious in its lead advocacy for better investment in security, awareness, technology and facilities to make all employees safe when at work. It seems to me our response should be health professional holistic rather than just doctor specific (i.e. protecting the team). We still want accessible and personable care for the public so excessive responses are to be avoided (think armed security in Victorian emergency departments previously batted off by AMA because the idea presented more dangers than it solved). CPHD will produce an AMA position to reduce workplace dangers in light of escalating population growth, mental health / substance abuse presentations and the anger born amongst some from frustrations at the lack of public hospital responsiveness and capacity.

Overall, your Council of Public Hospital Doctors is in the business of emerging trend identification and response. No doubt in 2018 some ‘curly’ policy pronouncement will emerge from government ranks but we are consultative, responsive and equipped to ensure our public patients and our public employed clinical ranks are protected from the excess of public service thought bubbles or political ideology.

I offer season’s greetings to all of our AMA membership family. It is important for all to ensure they have a sensible break and attend to personal well-being, family and friends, and to start 2018 refreshed and invigorated. See you in the New Year!

[Perspectives] Seven decades of fighting the five giants: a work in progress

On Dec 1, 1942, queues stretched from His Majesty’s Stationery Office along High Holborn in London, UK. By lunchtime all copies of Sir William Beveridge’s groundbreaking report, Cmd 6404 Social Insurance and Allied Services, had been sold. It was much the same story in provincial cities around the country. In Liverpool my father secured the two-volume report that today takes pride of place in my study. Beveridge’s report sits alongside works by others who have guided me in my public health career: Brian Abel-Smith, Douglas Black, Ann Cartwright, Karen Dunnell, Margot Jeffries, Jerry Morris, Richard Titmuss, Peter Townsend, and many others associated with the London School of Economics.

What the Medical Board’s revalidation reforms mean for doctors

Last week, the Medical Board of Australia announced a major shake-up in the way doctors’ professional performance will be assessed and monitored.

In response to a report on revalidation from its Expert Advisory Group, the Board released its Professional Performance Framework, which it says will “ensure all registered medical practitioners practise competently and ethically throughout their working lives”.

The Board says its Framework has been five years in the making and will be implemented progressively, with some elements ready to go, while others still need significant planning, consultation and development. “Nothing is going to change tomorrow for doctors in Australia,” cautions Board Chair Dr Joanne Flynn.

With that caveat in place, here are the key changes the Board says it will progressively implement:

Added scrutiny of older doctors

Medical practitioners over the age of 70 will undergo mandatory competency and health checks, which will include cognitive screening. The Board says there is strong evidence on age-related risk of poor performance and that addressing this issue to keep patients safe is a “must”.

Doctors over 70 will also need to have their performance peer-reviewed every three years. This review will involve observation of the doctor at work, a review of the doctor’s medical record and feedback and discussion with the doctor. The results of this review will not be transmitted to the Board unless the doctor is deemed to be a risk to his or her patients.

The Board says even problems are identified, it won’t necessarily mean that the doctor would have to stop practising. There could be other solutions, such as reducing work hours, not being on call, or not performing complicated procedures.

At the same time, the Board has explicitly rejected the idea of a mandatory retirement age for doctors.

In Australia there are around 6,600 registered doctors over 70, including 800 doctors over 80.

Peer review of doctors with a high number of complaints

The Board’s Expert Advisory Group report found that around 3% of doctors account for nearly half of all complaints made to regulatory authorities.

In its Framework document, the Board proposes a pilot scheme in which doctors with several substantiated complaints against them are obliged to undergo a formal peer review, the results of which would be reported to the Board for further action.

The Board says it is looking at whether the threshold number of complaints that would trigger such a process should vary by specialty, noting that some disciplines, such as cosmetic surgery, tend to attract many more complaints than others.

Isolated practitioners

The Board says that doctors who practise on their own rather than with colleagues, or who practice outside clinical governance structures, may be at higher risk of poor performance.

It says it will strengthen its CPD system for these doctors, and increase its peer-review component. This could involve practice visits from college-designated doctors.

New CPD requirements for all registered practitioners

All doctors will need a “CPD home” and will be required to complete at least 50 hours of accredited CPD, some of which must include peer-reviewed work. Doctors will also need a professional development plan, similar to the one already required by the RACGP’s CPD program.

The Board says a broad scope of CPD is important. A quarter of CPD hours should be devoted to developing skills and knowledge, a quarter to reviewing performance and a further quarter on measuring outcomes. The final quarter should involve a combination of the above.

Improved performance monitoring of medical graduates

The Expert Advisory Group in its report noted that risk of complaints is related to poor performance in medical school or specialty training.

It has proposed early intervention for medical students or junior doctors suspected of a lack of professionalism or of integrity issues, such as dishonesty.

“A proven and irremediable lack of professionalism may preclude entry to the profession of individuals who are unfit to practise,” its report says.

You can access both the expert advisory group’s validation report and the Professional Performance Framework proposals here.