THE chair of the Medical Board of Australia (MBA), Dr Joanna Flynn, believes more needs to be done to protect patients from poorly-performing doctors and has called on the profession to “take responsibility” for the way in which those doctors are identified.

Writing in the MJA, Dr Flynn said that she believed that “there are legitimate questions about who should be responsible for what in identifying and managing these practitioners, and about how to best manage the overlap between problems with health systems and concerns about performance of individual practitioners”.

“The opportunity now is for the medical profession to take responsibility, individually and collectively, for the future standards of medical practice in Australia. The board is seeking to work with the profession and the community to ensure that the high levels of trust and confidence that the Australian public has in doctors is based on an appropriate framework for ensuring the continuing competency of all those in practice.”

The MBA’s Expert Advisory Group (EAG) has recommended for discussion a set of risk factors to identify poorly performing doctors.

“The strongest risk factors associated with an increasing risk profile are practitioners aged from 35 years, increasing into middle and older age, male gender, number of prior complaints, and time since last prior complaint. Additional individual risk factors include primary medical qualification acquired in some countries, specialty, lack of response to feedback, unrecognised cognitive impairment, practising in isolation from peers or outside an organisation’s structured clinical governance system, insufficient levels of high quality CPD activities, and change in scope of practice.”

Dr Bastian Seidel, president of the Royal Australian College of General Practitioners (RACGP) told MJA InSight that the MBA had shown “good consultation and collaboration” so far in the process. “We are very confident that our views are being heard and will be acted upon,” he said.

However, he described the risk factors model as a “blunt instrument” which risked the mental health of members of targeted groups.

Dr Seidel, who is male, over 35 and trained in another country, told MJA InSight that the RACGP was concerned that the repercussions for members of the targeted groups had not been discussed.

“This is a blunt instrument,” he said. “The question is, are we doing any harm by screening those doctors? This hasn’t been discussed and we need to identify the significant risks.

“I would be one of the doctors identified as ‘at-risk’ and I would expect a call. I’d be wondering what happens next. It’s a whole new level of anxiety.”

Dr Flynn acknowledged that “further work is needed to better understand these risk factors” and that “all assessments would need to be non-punitive, tailored, educational and linked to remediation processes designed to return the doctor to safe practice as soon as possible”.

“The EAG also recognised that most doctors in the at-risk group will be able to demonstrate that they are practising appropriately.”

Dr Mark Colson, an anaesthetist in private practice in Geelong, and a co-author of a 2015 MJA article on revalidation, told MJA InSight that he would like to see “a more empirical approach to the measurement of outcomes, not based on value judgements”.

“There are four groups of doctors: bad people who are bad doctors – they’re easy to identify because their colleagues speak out; good people who are good doctors; good people who are bad doctors – they’re an interesting group because their patients love them and they will sail through the net; and bad people who are good doctors – these are the ones who get complaints against them all the time because of personality factors.

“If the system is complaints-based, then it’s possible that good doctors may be penalised because of their personality, rather than their competency.

“Medicine needs to be a broad church, and [this reform] has the potential to become a weapon for weeding [the outliers] out.”

Dr Flynn wrote that “patients trust their doctors”.

“The profession as a whole, and the MBA as the regulator, are responsible for ensuring this trust is well founded.”

The EAG will make its final report to the MBA in mid-2017.

A podcast with Dr Joanna Flynn is available here.

 

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Poll

I like the Medical Board's criteria for "at-risk" doctors
  • Strongly disagree (52%, 27 Votes)
  • Disagree (27%, 14 Votes)
  • Neutral (13%, 7 Votes)
  • Agree (6%, 3 Votes)
  • Strongly agree (2%, 1 Votes)

Total Voters: 52

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12 thoughts on “Medical Board seeks feedback on “at-risk” doctors

  1. ex doctor says:

    Profiling such as this in any other context would have the civil liberties guardians frothing at the mouth. Just how big is this massive problem that so occupies the Medical Board of Australia or is it politically driven?

  2. Anonymous says:

    It is an increasing problem in isolated areas- particularly where there are single operators.

    I would like to propose a fifth group of Doctors- either good or bad but also greedy. Those who refute the enhancement of services in an area where clinically indicated , through intimidation and disparagements to maintain service monopolization

  3. Andrew Nielsen says:

    WTF? If the Board wants a discussion, they need to provide more information. Like 1) in what way the risk factors are independent or dependent, and 2) the positive predictive value of the risk factors. On one hand Joanna Flynn did not emphasise the role of risk factors. On the other hand, she brought up the issue and left it hanging. Perhaps the MJA could commission an article where some effort is made to think these issues through?

  4. Anonymous says:

    I think this is just Empire Building by AHPRA, These impaired doctors, how many are from not England, Canada NZ or Australia? (lots) . The UK experience has shown just how useless this intensive surveillance is…

    I would completely forgive Dr Flynn if only she would go first – and have it all publicly available.

  5. Anonymous says:

    Seriously? The medical council has gone so far as to protect the public, will there ever be any protection for doctors with medical conditions (psychological or physical)? The jury is still out on the effects of mandatory reporting and whether or not it prevents doctors from seeking the appropriate medical treatment they need!

  6. Rosemary Swift MBB FRCS FRACS says:

    I suggest all members of the medical board are themselves tested for competency/CPD/health etc.Before they start on their colleagues,

    These doctors that they are sitting in judgement on ,have often done 10 years training/ continue to train/ are always learning =CPD.
    They have people investigating with little or no competency who do not know or understand the specialist training they don’t know the work the person does .Yet they sit in judgement ! Who gives them the competency to do this ? They don’t have it, it is old boys and all girls club. They put forward themselves !They elect each other!
    The people who work on the medical board need to be thoroughly tested for competency regularly etc before they sit in judgement on their colleagues.

    I think Occupational Health& Safety for the general public has become lopsided .The Medical Board will sacrifice a doctor’s career for very little
    It is carried too far in many cases.
    I would like to see an HCCC-like Office designated for doctors who have had vexatious patients who at the present time are allowed to get away with complaints without foundation. The doctor has no where to go about these problem people.

    Let’s give a level playing field to all doctors who work very hard in Australia ,and let’s give the doctors somewhere to put a word in about the very few patients that can be extremely unpleasant and difficult, because the rules of Occupational Health& Safety allow them to get away with it the doctor gives in for the sake of peace ,because the doctor has nowhere to go

  7. Roger McMaster-Fay MRCOG FRANZCOG says:

    What about conflict of interest?
    As a specialist, I have experienced complaints from ‘colleagues’ who practice in the same region / hospitals as I do.
    There is a very real probability that their complaints about operative complications (few and not related) were, in no minor degree, to ‘dispense with competition’. The hospital immediately suspended my practice until outcome of investigations by the medical Board, which are still ongoing even though no limitation has been placed on which operations I can perform. Thus the end of my long surgical career. I do not believe that Dr Joanna Flynn is living in the real world and attitudes like hers age going to wreak medical professional carnage.

  8. Anonymous says:

    I am amazed at the risk factor profile.
    With age > 35 being one , I am afraid that a majority of doctors are in this group.

  9. Andrew McIntyre says:

    I have experienced the blatant use of vexatious complaints which succeeded in ousting GP sedationists from a local private hospital, despite the fact that none of the complaints against the GPs were upheld and many have a 20yr history of safe efficient practice. Blind freedy could have seen that the complaints were commercially motivated and there was good evidence of this presented to AHPRA but they do not reach the competency of Blind Freddy and allow bullying in the name of patient safety.

    AHPRA have admitted, in the senate inquiry that only 25% of their investigators have ANY medical or nursing training and its time that the quality of AHPRA investigations was examined as I suspect its a major danger to the public and results in perverse outcomes.

  10. Anonymous says:

    THERE ARE NO GOOD NOR BAD DOCTORS -JUST DOCTORS
    THEY ARE COMPETENT OR INCOMPETENT. THEY MAY BE HONEST OR DISHONEST ,
    THERE ARE GOOD PEOPLE WHO ARE DOCTORS WHO MAY BE LIKED OR DISLIKED
    THERE ARE BAD PEOPLE WHO ARE DOCTORS WHO MAY BE LIKED OR DISLIKED
    THERE ARE REASONABLE PEOPLE AND THERE ARE UNREASONABLE PEOPLE
    THE MAJORITY OF WORKING DOCTORS ARE UNCOMFORTABLE WITH AHPRA AND MEDICAL BOARDS WHICH IN MANY WAYS WITH THE POWER ALLOCATED TO THEM APPEAR VERY MUCH AS KANGAROO COURTS.SIGNIFICANT ISSUES SHOULD BE DEALT WITH BY THE NORMAL LEGAL SYSTEM WITH PROPER GATHERED EVIDENCE NOT SIMPLY ON NON PEARE BASED SO CALLED EXPERT OPINION ON HEARSAY AND POOR EVIDENCE. A JURY AND IMPARTIAL JUGE IS THE ONLY ACCEPTABLE FORM OF CONFLICT RESOLUTION.
    DOCTOR PATIENT RELATIONSHIP IS A MORE COMPLEX VARIABLE THAN PILOT-AEROPLANE INTERACTION

  11. Anonymous says:

    It seems that Dr Flynn is guilty of “begging an enormous question”. We are already running on the track that “New Revalidation” is called for when no evidence has been presented that there is anything wrong with “Old Revalidation”. The colleges have been doing this job with CPD programs, so why does AHPRA have to interfere and add enormously to time and cost to re-invent the wheel. If there are problems with the present system let’s improve it but let’s not go for this enormous, unnecessary and illogical clean sweep. Calling CPD a new name is no reason to replace it.

  12. Anonymous says:

    AHPRA and Dr Flynn have to justify their huge registration fees and expensive bureaucracy by making life just that bit harder for people using their medical degree to treat the sick.

    Her last “job” on me was to take away all rights to practice that I took 17 years to acquire because I retired.

    AHPRA is a barnacle on the hull of Australian medical practice.

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