The 13th International Conference on Medical Regulation, hosted by the International Association of Medical Regulatory Authorities (IAMRA) was held in Dubai in October. Held every two years, and attended by medical regulators, academics and representatives from professional bodies and associations, the IAMRA Conference provides an opportunity to learn about international developments in medical regulation and to share ideas and the latest research in the area.
Many jurisdictions are facing increasing patient complaints, including in developing countries, so what we are seeing in Australia is a global phenomenon. There is an increase in complaints that are not upheld by the regulator, putting pressure on regulators’ resources.
Work pressures, burnout and systems issues were recognised throughout the conference. A plenary session commenting on the learnings from Dr Bawa-Garba’s case in the United Kingdom recognised that individuals work as part of a system and the role the system places in errors in health. Focusing solely on individual accountability in the absence of considering systems issues adds to a culture of blame. The General Medical Council (GMC) noted that the profession’s response to the case was unexpected. The GMC frankly acknowledged that the case caused significant damage to its relationship with the medical profession, and that it needed to rebuild the trust that was lost.
AHPRA presented on the work it is doing on the notifier and practitioner experience of the complaints process and improvements it is seeking to make in this regard.
Late career doctors
There were several presentations on late career doctors. It is recognised that older doctors can be at higher risk, although the effect of age on an individual’s competency is highly variable. In several Canadian provinces, the regulator requires that doctors over 70 be assessed annually (similar to the Medical Board of Australia’s Professional Performance Framework proposal for doctors aged over 70), whereas there are no requirements in other jurisdictions. One presenter noted that it was easier in their state to renew their medical licence than to renew their drivers’ licence. There was a call for more education resources for doctors transitioning to retirement, and for doctors to become more self-aware of the effect of age on their ability to practice.
Many regulators are taking an educative approach to medical regulation, particularly on opioid prescribing, which is a significant problem in the United States and Canada. In Alberta for example, regulators use prescribing data to benchmark doctors and seek to educate them about appropriate prescribing. This is similar to the approach taken recently by the Commonwealth Department of Health to curb inappropriate antibiotic and opioid prescribing. While these projects attracted some criticism in Australia, it is interesting to see that this approach is being used internationally as an alternative to disciplinary action.
Avant participated in two presentations. The first outlined the education plans that our Risk Advisory team assists our members with, when deficits in their practice are identified by the regulator during a disciplinary process. There was interest from Australian and international regulators in obtaining further information about our approach.
The second was a panel discussion following a presentation from Professor Ron Paterson about his review into chaperones, to which we made a submission. The panel discussion included representatives from Ontario’s medical regulator (the College of Physicians and Surgeons of Ontario), the Medical Board of Australia, Avant and AHPRA, discussing the various views and approaches to the use of chaperones in matters involving allegations of sexual boundary violations.
Overall, the approaches taken to medical regulation in Australia are similar to those taken internationally, especially in Canada and the United Kingdom. Pleasingly, there was a focus during the conference on the wellbeing of the doctor during the complaints process. In response to several doctor suicides during the complaints process, the GMC is implementing many initiatives to reduce the impact on the doctor (many similar to those that have been implemented by AHPRA in Australia). It was mentioned several times during the conference that there is a need to balance public protection with fairness to the doctor. This is an interesting contrast to the same conference four years ago, where the focus was on community involvement in medical regulation.
Avant offers a range of online education resources developed by our medico-legal experts to assist our members to manage risk, accessible through the Avant Learning Centre.