CPD audits: what you need to know

Although it’s been three years since AHPRA started randomly checking medical professionals’ declarations about their CPD activities, many doctors are still unaware that they can be audited.

Particularly vulnerable to being caught out are IMGs, doctors in training and non-vocationally registered doctors, who are not affiliated with a college and so don’t get the same prompts that other doctors get from their college to do their required CPD.

Here’s some key information about the auditing process:

Doctors under audit are sent an audit notice, and have 28 days to demonstrate that they’ve met the Medical Board of Australia’s registration requirements.
This includes not only CPD requirements, but also declarations about indemnity insurance, recency of practice and criminal history. If found to be in breach in any of these areas, doctors can be reported to the Board.
Doctors who belong to a college need to meet the CPD standards set by their college. But those who are not on the specialist register – whether they are in training or are simply non-VR doctors – must also demonstrate that they have fulfilled CPD requirements.
For non-VR doctors, this involves a minimum of 50 hours of CPD per year, which can be self-directed. Any self-directed program must include one mandatory self-assessment reflection activity or peer review, clinical audit or performance appraisal. Activities to enhance medical knowledge, such as participation in courses, conferences or online learning, are also required.
Trainees will need a signed letter or report from their supervising hospital to confirm your participation in training and education programs in the year being audited.

See here for more information on CPD requirements for junior medical officers, IMGs and non-VR doctors.

Sign up to Doctorportal Learning to access mobile-friendly medical education, track all your CPD points and activities in one place, and get assistance in meeting your MBA CPD reporting obligations.

[Articles] Mortality risks associated with emergency admissions during weekends and public holidays: an analysis of electronic health records

Adjustment for routine test results substantially reduced excess mortality associated with emergency admission at weekends and public holidays. Adjustment for patient-level factors not available in our study might further reduce the residual excess mortality, particularly as this clustered around midday at weekends. Hospital workload was not associated with mortality. Together, these findings suggest that the weekend effect arises from patient-level differences at admission rather than reduced hospital staffing or services.

Hospital resources 2015–16: Australian hospital statistics

In 2015–16, there were 701 public hospitals in Australia accounting for about two-thirds (61,000) of all hospital beds. There were 630 private hospitals with 33,100 hospital beds. Total recurrent expenditure on public hospital services was about $64 billion. About 57% of this was for admitted patient care, 18% for outpatient care, 10% for emergency care services, 2% for teaching, training and research and 13% for all other services.

Study quantifies junior doctor distress

Australian junior medical officers (JMOs) suffer from dangerously high levels of psychological stress that are considerably greater than in the general population, according to new research published in the Internal Medicine Journal.

The study of over 1,000 JMOs surveyed between 2014 and 2016 assessed distress according to the commonly used Kessler Psychological Distress Scale (K10). The average score was 18.1, compared with 13 in the general Australian population shown in previous studies.

Unsurprisingly, increasing hours of work correlated with higher distress, with every extra hour worked per week increasing the odds of a high K10 score by 3%.

Smoking and drinking alcohol as ways of relieving stress were correlated with higher levels of distress, as was taking illicit drugs, which 7.7% of those surveyed admitted to doing.

Feeling ill-equipped during internship and workplace bullying were also associated with higher distress levels.

On the other hand, spending time with friends or family correlated to lower levels of distress.

Only 17% of those surveyed had resorted to professional help for their psychological distress. GPs were most commonly the first port of call, followed by private psychologists or psychiatrists.

Worryingly, nearly 20% of JMOs said that if they had their time over again, they wouldn’t choose to do medicine.

The researchers from Sydney’s Nepean Hospital said that theirs was the first study to measure psychological distress in Australian JMOs over a three-year period. The bulk of existing literature relies on data from overseas, they noted, and even that literature was skewed towards senior clinicians rather than junior doctors.

They wrote that although long hours correlated with increased distress, one of the issues was the difficulty of accurately monitoring how many hours JMOs worked, due to a culture of unpaid overtime.

They said their work demonstrated the need for a more focused approach to JMO support and education, encompassing increased administrative support, education on coping strategies and action around bullying behaviour.

You can read the study here.

The Australian Medical Association has a wide range of online resources for junior medical officers on its website.

For more information about health issues for doctors, access online resources from Doctors’ Health Services Pty Ltd.

Maternity services framework to be redrafted

Work has been terminated on a controversial new framework for maternity services that was drawn up with no input from obstetricians or GPs.

The Australian Health Ministers’ Advisory Council (AHMAC) agreed to start afresh on a new draft following a hostile stakeholder consultation meeting on 23 June at which not a single stakeholder voiced support for the project.

Both the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the National Association of Specialist Obstetricians and Gynaecologists (NASOG) boycotted the meeting in protest.

AMA Federal Councillor Dr Gino Pecoraro, who represented the AMA at the meeting, said that the stakeholders – doctors, nurses, midwives and health consumers – were united in their opposition to the proposals.

“The decision to scrap the National Framework for Maternity Services (NFMS) is a win for the women and children of Australia,” Dr Pecoraro said.

“What has happened has been a monumental missed opportunity to achieve the best possible maternity care for mothers and babies.”

The NFMS was designed as a guide for future maternity care policy in Australia. Following an agreement at the April 2016 COAG Health Council, the Queensland Government was tasked with leading the project, under the auspices of AHMAC.

The AMA first became aware of the NFMS project in December 2016 – eight months after it commenced, and without any direct contact from AHMAC’s 12-member Maternity Care Policy Working Group (MCPWG) or consultants Deloitte.

AMA President Dr Michael Gannon raised the AMA’s concerns with federal Health Minister Greg Hunt and Queensland Health Minister Cameron Dick.

“If it was an episode of Yes Minister or Fawlty Towers, you could have a bit of a laugh,” Dr Gannon told Medical Republic.

“Even if you had a predicted outcome in mind, you could at least window-dress it with one obstetrician or one GP.”

AMA Vice President, Dr Tony Bartone, said that obstetricians and GPs share the bulk of the care for women throughout their pregnancies, and leaving them out of the process was a critical misjudgement.

“The AMA has consistently warned that without genuine engagement with the medical profession, the review would be doomed to fail – which is exactly what has happened,” Dr Bartone said.

“The AMA remains committed to working with Government and all stakeholders to see a strong and safe framework.”

Following the stakeholder meeting, Queensland Health representatives recommended to AHMAC that the current process be terminated, replaced with a more substantial consultation phase, and a complete redrafting of the Framework.

The Australian College of Rural and Remote Medicine (ACRRM) and the Rural Doctors Association of Australia (RDAA) said the decision to start again was the right one.

“RDAA and ACRRM were very concerned there had been no specific consultation with rural clinicians, no recognition of the role of procedural GPs in rural maternity services, nor any mention of the guidelines developed by RANZCOG, the organisation that trains the procedural GPs and specialists in this field,” RDAA Vice President Dr John Hall said.

“With over 34,000 babies born each year in locations classified as outer regional, remote and very remote, it is essential that rural maternity service models are supported as part of the NMSF – and that the doctors who provide care as part of these services are closely consulted in its development.”

Maria Hawthorne

[Series] Coming of age: health-care challenges of an ageing population in Israel

Although Israel is still young in years, with relatively high birth rates and older people (individuals aged 65 years or older) constituting only about 11% of its population, the absolute number of older people is growing rapidly. Life expectancy is high, and increasing numbers of people are living to advanced old age (older than 85 years). A wide spectrum of geriatric care is provided within a universal system providing health services to all citizens. Community and institutional care is available, and many innovative programmes are being developed.

[Series] Health and health care in Israel: an introduction

Starting well before Independence in 1948, and over the ensuing six decades, Israel has built a robust, relatively efficient public system of health care, resulting in good health statistics throughout the life course. Because of the initiative of people living under the British Mandate for Palestine (1922–48), the development of many of today’s health services predated the state’s establishment by several decades. An extensive array of high-quality services and technologies is available to all residents, largely free at point of service, via the promulgation of the 1994 National Health Insurance Law.

[Series] Maternal and child health in Israel: building lives

Israel is home to a child-oriented society that values strong family ties, universal child benefits, and free education for all children from 3 years of age to school grade 12. Alongside the universal health-care services that are guaranteed by the National Health Insurance Law and strong, community-based primary and preventive care services, these values have resulted in good maternal and child health. In 2015, infant and maternal mortality (3·1 deaths per 1000 livebirths and 2·0 deaths per 100 000 livebirths, respectively) were lower than the mean infant and maternal mortality of countries within the Organisation for Economic Co-operation and Development.

Yemen cholera outbreak claims one life every hour

The rising number of suspected cases of cholera resulting from a severe outbreak in Yemen has passed 100,000, the World Health Organization (WHO) reports.

Cholera is affecting the most vulnerable. Children under the age of 15 years account for 46 per cent of cases, and those aged over 60 years represent 33 per cent of fatalities.

Cholera, an acute enteric infection, is caused by the ingestion of food or water contaminated with the bacterium Vibrio cholera. It can kill children within just a few hours. Cholera should be an easily treatable disease when there is access to functioning medical services.

WHO believes that cholera is primarily linked to insufficient access to safe water and proper sanitation and its impact can be even more dramatic in areas where basic environmental infrastructures are disrupted or have been destroyed.

Humanitarian partners have been responding to the cholera outbreak since October 2016. However, Yemen’s health, water and sanitation systems are collapsing after two years of war. The risk of the epidemic spreading further and affecting thousands more is real as the water hygiene systems are unable to cope.

The UN Office for the Co-ordinatior of Humanitarian Affairs (OCHA) Jamie McGoldrick said the fast spreading epidemic in Yemen was “of an unprecedented scale”.

Mr Goldrick also fears that hundreds of thousands of people are at a greater risk of dying as they face the “triple threat” of conflict, starvation and cholera. He believes the cause is clear.

“Malnutrition and cholera are interconnected; weakened and hungry people are more likely to contract cholera and cholera is more likely to flourish in places where malnutrition exists,” Mr Goldrick said.

More than half of Yemen’s health facilities are no longer functioning, with almost 300 having been damaged or destroyed in the fighting.

Systems that are central to help treat and prevent outbreaks of the disease have failing in Yemen. Fifty per cent of medical facilities no longer function. Some have been bombed and others have ground to a halt because there is no funding.

The International Committee of the Red Cross (ICRC) Director of Operations Dominik Stillhart said: “Hospitals are understaffed and cannot accommodate the influx of patients – with up to four people seeking treatment per bed. There are people in the garden, and some even in their cars with the IV drip hanging from the window.”

Local health workers, including doctors and nurses have not been paid for eight months; only 30 per cent of required medical supplies are being imported into the country; rubbish collection in the cities is irregular; and more than eight million people lack access to safe drinking water and proper sanitation.

UNICEF is reported to have flown in over 40 tonnes of medicines, rehydration salts, intravenous fluids and other life-saving supplies to treat approximately 50,000 patients in Yemen.

Meredith Horne

Alcohol and other drug treatment services in Australia 2015–16

In 2015–16, about 796 alcohol and other drug treatment services provided just over 206,600 treatment episodes to an estimated 134,000 clients. The top 4 drugs that led clients to seek treatment were alcohol (32% of treatment episodes), cannabis (23%), amphetamines (23%), and heroin (6%). The proportion of episodes where clients were receiving treatment for amphetamines has continued to rise over the 5 years to 2015–16, from 12% of treatment episodes in 2011–12 to 23% in 2015–16. The median age of clients in AOD treatment services is rising, from 31 in 2006–07 to 33 in 2015–16.