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.
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.