Physician health and impairment in Australia: unsettled times.

• Author: Breen, Kerry

In recent years, the health and well-being of medical students and doctors in Australia has been extensively discussed and written about by a wide range of organisations including the Australian Medical Students Association, the Royal Australian College of General Practitioners and the Australian Medical Association. (1) This has resulted in some excellent documents that provide detailed advice to students and medical practitioners about how to maintain health and wellbeing. Over the same period of time, the long standing state--based [dagger] doctors' health advisory services (DHASs) have joined forces to establish the Australasian Doctors' Health Network (which also includes the New Zealand DHAS) and a national conference on doctors health is convened every second year. Available data indicate that Australian medical students and doctors experience similar degrees of stress, burnout and anxiety as do their counterparts in other developed nations. Mental illness including depression and suicide, alcohol and other substance abuse, and other illnesses associated with potential impairment also occur with similar frequency. (2) Thus the work of medical regulators and doctors' health services in Australia is likely to be very similar to that of their Canadian counterparts.

Despite the existence of firm ethical guidance to doctors from both the Medical Board of Australia (3) and the Australian Medical Association, (4) approximately 50% of Australian doctors do not have an identified general practitioner (family doctor) and many choose to self-diagnose, self-prescribe or self-refer for investigations or to specialists. (5) Under the national health care system (Medicare), self-referral by doctors unfortunately is permitted. While medical schools are now placing greater emphasis on educating students about their professional responsibilities in regard to their own health and the need for doctors to have their own general practitioner, it is too early to determine if this is having any impact on behaviour.

Doctors' health advisory services exist in every state and territory. (6) These organisations are staffed predominantly on an honorary basis and provide telephone advice and triage for distressed doctors and medical students. Advice can be sought anonymously and the service is confidential. The exceptions are in Victoria and South Australia. In Victoria in 2001, the then Medical Practitioners Board, in partnership with the Victorian Branch of the Australian Medical Association, established the Victorian Doctor's Health Program (VDHP), funded fully from annual medical registration renewal fees but managed at arm's length from the Medical Practitioners Board by an independent board. (7) Partly based on similar programs that have long existed in North America, VDHP provides free assistance to doctors and medical students via face to face triage and referral, care and monitoring agreements, support for families, rehabilitation and re-entry to work, education for the profession and research. More recently, South Australia has established a different service mode1. (8)

This relatively stable situation has been disturbed by the introduction in July 2010 of a new national scheme for the registration of all health professionals. Under this scheme, the Medical Board of Australia has assumed the role previously played by the state and territory medical boards. The new scheme was five years in the making, commencing with a 435 page report commissioned by the Council of Australian Governments and prepared by the Australian Productivity Commission in 2005 entitled "Australia's Health Workforce." (9) This led to the establishment of the Australian Health Practitioners Regulation Agency (AHPRA) (10) covering the registration of all health professionals and the accreditation of providers of health education and training. The new law is known informally as the "national law" but its formal title is the Health Practitioner Regulation National Law. (11) Thus Australia now has a single national agency (AHPRA) under which sit fourteen health profession specific national boards, one of which is the Medical Board of Australia.

The objectives of the "national law" in summary are to protect the public, facilitate workforce mobility, facilitate the provision of high quality education and training, facilitate access to services, and to "enable the continuous development of a flexible, responsive and sustainable Australian health workforce and to enable innovation in the education of, and service delivery by, health...