Doctors to be dumped on the scrap heap

A growing number of Australia's senior doctors are calling on state, federal and territory government health ministers to support their right to continue to participate in their profession.  The Australian Senior Active Doctors Association (ASADA) was incorporated in May.

The issue at stake is the intention by the recently appointed national regulator, the Australian Health Practitioner Regulation Agency (AHPRA), to abolish a registration category entitled Limited Registration Public Interest Occasional Practice (LRPIOP) from 1 July 2013, having closed the category for new entrants from 1 July 2010.

Doctors on the LRPIOP Register have maintained some rights of writing repeat prescriptions and referring.  These would be lost once the category is abolished, meaning the doctors in this category could not render any assistance to any person which involved practice as defined by the Medical Board of Australia (MBA). The MBA definition is “Any role, whether remunerated or not, in which the individual uses their skills and knowledge as a health practitioner in their profession. For the purposes of this registration standard, practice is not restricted to the provision of direct clinical care. It also includes using professional knowledge in a direct non-clinical relationship with clients, working in management, administration, education, research, advisory, regulatory or policy development roles, and any other roles that impact on safe, effective delivery of services in the profession”.

The registration categories were created in 2010 as part of a controversial centralisation of registration of all health occupations under the control of the new AHPRA bureaucracy, which took control of nearly 500,000 health workers.  

“A grave injustice is being perpetrated on 1800 Australian doctors, who will be thrown out of their profession from 1 July 2013 when the registration category LRPIOP will end,” said Stephen Milgate, Executive Director of the Australian Doctors’ Fund (ADF).

“Under the national registration scheme introduced in July, 2010, there are hundreds of other senior doctors who have been denied the right to apply for the occasional practice category, when entry to the LRPIOP category was closed.

“The result has been hundreds of senior doctors not being able to use their medical knowledge in any way since to do so would breach the regulations of unregistered practice. This is an absolute waste of some of the most exceptional talent in Australian medicine.”

A meeting of the ADF held at St George Leagues Club on 4 March 2012 is part of a move by doctors nationally to defend their senior colleagues’ right to be treated fairly and justly by the new national registration system, introduced by former state governments and bureaucrats using the COAG process.

The ADF unanimously passed a motion at that meeting supporting the establishment of a permanent registration category for Occasional Practice, to be renamed Senior Active, and that it be made available to all medical practitioners who choose to transition from the general register for doctors or for whom the classification has been previously closed.

 “We have an existing category for Occasional Practice.  It has worked well.  All that is required is for AHPRA to make this a permanent open category. Experienced doctors are worth their weight in gold.  They should not be shut out of the system,” said Mr Milgate.

The chairman of the Retired Doctors Working Party of AMAQ, Dr Frank Johnson said, “What is happening is an outrage.  We have seen senior doctors denied access to the Occasional Practice category from 2010 and those who are in this category will be going in the same direction in 2013 – on the scrapheap.”

Former President of the Royal Australian & New Zealand College of Psychiatrists, Dr Richard Prytula, said the registration system defied common sense.

“These senior and very experienced doctors are fit and willing to continue to contribute their knowledge and expertise to communities, in Australia and overseas, in many different ways. The proposed lack of appropriate registration deprives both these doctors and the communities of this wealth of potential benefit and fails the test of common sense.”

The ADF meeting heard numerous examples of highly qualified and eminent medical practitioners who were no longer able to help with overseas medical aid and assisting the local community because they had been shut out from the register even though they were fit and willing to contribute their services.

An ophthalmologist, for example, who provided medical services to Aboriginal people, screening for diabetic related eye disease, had discontinued his volunteer work because he couldn’t maintain full medical registration. After he discontinued his monthly screening of indigenous people, there was no one to replace him.

Professor Geoffrey Dobb, Vice President, Federal AMA, told the meeting that AHPRA was a “bureaucratic insanity” which was ineffectively regulating the industry.

“We urge the Medical Board of Australia to have a category of registration that can provide for doctors transitioning to retirement or who are retired and for those who work part-time.

“We know there are many of them, such as women who have had children and have family responsibilities and are able to work only for a small part of the week, but who wish to maintain their medical skills so they can transition back into full-time medical practice in the future.

“This is a very important part of our work force,” said Professor Dobb.

“Our colleges manage to be able to maintain a system of reduced fees for people who are in part-time practice. Our medical indemnity insurers manage to do it, and yet AHPRA says that if they were to do it, it would be hugely complex and mean that every other medical practitioner would have to pay a huge amount more.

“I don’t think that is defensible in today’s society where we have really good information and good membership systems that are fully automated,” Professor Dobb said.

Stuart Boland, Chairman of Avant Medical Indemnity, told the ADF meeting that the current situation led to a conflict between a doctor’s ethical responsibility and the law.

Dr Boland highlighted the need for such a registration category by quoting the experience of a friend, a cardio-thoracic surgeon, who faced an ethical dilemma under existing registration rules.  

“The surgeon had retired from public hospital work and was made director of undergraduate and postgraduate training at the hospital in which he had practised.  One year after that, a patient who had been stabbed through the chest entered the emergency department of that hospital. An emergency surgeon got the patient into theatre, but was able to control bleeding from the patient’s heart only by inserting his thumb and leaving it there. As soon as he took his thumb out, the bleeding started again.

“The emergency surgeon requested the help of a cardio-thoracic surgeon working within the hospital but none was available.  He started to panic and sought the help of his colleague who was the cardio-thoracic surgeon. The surgeon responded that while he would love to help, it was illegal for him to help as he was no longer in practice, but that he would ring the superintendent of the hospital and ask him if there was anything to do that could legitimise his participation.

“But the superintendent wasn’t available either, so he made the decision to go into the theatre. He didn’t gown, but he gave the emergency surgeon some advice, and the matter ended happily.”

Dr Boland said that doctor’s ethical responsibility drove him to help in the theatre even though he was practicing unregistered under existing arrangements. That story alone justified the need for a temporary registration category for senior doctors seeking to work occasionally.

“A life time of service with the noblest of professions deserves some sort of a meritorious status and the LRPIOP registration is something which supports that,” Dr Boland said.

“Avant, and I believe all medical insurers, would take the risk [of such registration].”

Dr Adrian Sheen, President, Doctors Action, said costs were relevant to a doctor’s decision to continue to practice. General registration involved having to pay full medical indemnity insurance costs, which some retired doctors could not meet, despite the reduced risk they posed.

“Costs are important to many members of the profession, particularly to people who are retired and on a fixed income,” Dr Sheen said.
The Hon Bronwyn Bishop, Shadow Minister for Seniors, said seniors, or those aged over 50, represent 30% of the population and 40% of voters, and their views were important.

“My aim is to make it as offensive to be ageist as it is to be sexist or racist.  I understand entirely why you want to have your qualifications continued to be recognised and to continue to utilise them.”

She said any Coalition government would listen to the needs of senior doctors.

“We will keep the door open. Tony Abbot has said that if he is successful at being elected at the next election the Minister for Seniors will be a Cabinet position, so you will have people who are very sympathetic to your views.”

The ADF has also called on the definition of medical practice to be defined in a way which would allow senior doctors to share their knowledge with others without being branded as ‘practising.’

“If a doctor is not on the register and uses their medical knowledge in any way, they run the risk of practising the profession unregistered as practising is currently defined. This is in absolute conflict with the ethic that our doctors have a duty of care to all those who need their help,” Mr Milgate said.

“Hence we propose that medical practice means any role in which medical practitioners use their professional discretion within the limits of their knowledge, skill, and training as medical practitioners for the direct or indirect benefit of patients.”

“The overwhelming number of doctors in Australia supports our senior doctors and our stand,” Mr Milgate said.

ADF estimates that there more than 18,000 doctors over the age of 55 practising in Australia. Non-medical senior citizens who learn of the way AHPRA and MBA are treating senior doctors are surprised, dismayed and resentful. With more than 40% of voters being aged more than 50, senior citizens are a potentially powerful force for politicians to consider.

It must be emphasised that, contrary to some statements that have been made, senior active doctors do not want to treat their own families and themselves. On the contrary, it has always been their strong belief that the doctor and his/her family should have their own family GP and/or specialist/s.

The writing of repeat prescriptions with the approval of the GP and writing referrals with the report to go to the GP or specialist is of assistance to the GP or specialist and in accord with bipartisan policy that senior citizens should be encouraged to contribute to the community for as long as they can.

ASADA plans to call on all state, federal and territory government health ministers to support continuation of the LRPIOP registration permanently instead of abolishing it on 30 June 2013 and to enable those hundreds of doctors who were not allowed to enter that category after 1 July 2010 to apply for that category should they wish to do so.

It is to be hoped that when the category of limited registration is continued and restored, senior active doctors will pay reduced registration and medical indemnity fees appropriate to their level of professional involvement, and undertake commensurate reduced CPD.

Check the ASADA website, By joining ASADA as a member or supporter you can help to raise awareness of the issue in our profession and in the general community so that the politicians will know that grey power is on their side if they support the measures that ASADA is advocating.

Dr Frank Johnson, ASADA President.
Dr Meredith Kaesehagen, ASADA Secretary,
Prof Philip Morris, ASADA Treasurer.
Mr Stephen Milgate, ASADA National Coordinator.