REVISED INTERPRETATION OF DEFINITION OF MEDICAL PRACTICE: RACP News / JUNE 2012
One of the most contentious issues arising from the national medical registration legislation which came into force in Australia in 2010 was the definition of practice for the purpose of registration.

Here, Professor Richard Doherty (Dean of the College of Physicians) explains the background to this issue and the implications of the reinterpretation of the definition released in March this year.

In the past, many retired medical practitioners were able to retain a form of ‘non-practising’ registration which allowed them to write prescriptions, make referrals and take part in a range of activities such as teaching, research and assessment. The specifics of the various categories of this type of registration varied between the different state Boards, but a significant number of doctors who had ceased clinical practice took advantage of the arrangements and provided service of tremendous value to medical schools as clinical teachers as well as to Colleges and to the Australian Medical Council (AMC) in a range of committee and assessment roles. Under the new National Law, all of these activities were deemed to be a form of medical practice and the Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board of Australia (MBA) advised that full registration was required for continued participation even where no patient contact or clinical responsibility was involved. This requirement was complicated further by the new requirements for renewal of registration: participation in a compliant program of continuing professional development (CPD) and the demonstration of medical indemnity cover. It quickly became evident that there were substantial costs of compliance with these requirements even though the great majority of affected doctors were earning little or no income from the ‘practice’. Apart from the individual frustration and distress associated with this requirement, there was a clear likelihood that many committed teachers and examiners would see no alternative but to cease these activities and retire fully. This expectation was soon fulfilled.

The College, along with other organisations, made vigorous representations to the MBA over a prolonged period to seek a solution to the problem, arguing that despite the MBA’s overall obligation to protect the community these activities did not require full medical registration. In many cases, the activities considered medical practice for the retired group were the same as those acknowledged as professional development for active clinicians, and the question of what would then constitute suitable CPD for the affected group became a moot and largely unanswerable point.

Initial responses from the MBA emphasised their view that these activities did indeed constitute medical practice and the philosophical impasse continued for some time, with continued representation to the MBA by the Committee of Presidents of Medical Colleges (CPMC) and the AMC in particular. In March 2012, however, the MBA issued a revised interpretation of the definition of medical practice which now accommodates participation in teaching, research and assessment activities by practitioners who do not hold full medical registration. It is important to note that this is not a revision of the definition, but rather advice regarding the interpretation of it. The Board’s advice can be found by searching their website (www.medicalboard.gov.au) with the term ‘who needs to be registered’, and should be read carefully by anyone wishing to take advantage of the revised interpretation of the definition of practice. For example, it specifies that registration would not be required ‘in settings that involve simulated patients or settings in which there are no patients present …’ This would logically lead to the interpretation that clinical tutors who take students or trainees to see patients, even where there is no responsibility for care or clinical decisions, would still need to be registered as a medical practitioner.

This issue will be revisited as part of the planned review of registration standards in 2013, and the RACP will continue to argue for a sensible and appropriate definition of practice which allows physicians in the later phases of their careers to continue to make contributions to teaching, assessment and research. The enormous contributions to the profession made by this cohort of our Fellowship would be sadly missed if an appropriate definition is not reached.

Professor Richard Doherty
Dean of the College of Physicians
College of Physicians RACP News; Volume 32, number 3, June 2012, page 22.