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Overview: the experience of the New South Wales Medical Board

Alison M Reid
Med J Aust 2002; 177 (1): S25. || doi: 10.5694/j.1326-5377.2002.tb04626.x
Published online: 1 July 2002
Activities of medical boards

Registration of medical practitioners (and, in NSW, medical students): The core activity of all boards is the registration of medical practitioners, ensuring that their qualifications meet a required minimum standard. In NSW, medical students are also registered. This came about when the Board recognised that, each year, a number of young doctors coming to the Board's attention because of illness had problems dating back to their student years. The Board recognised that if it could have been involved earlier the transition of these students to the workforce may have been much smoother. Student registration has been in place in NSW since 1992. The only provisions of the NSW Medical Practice Act 1992 that apply to students are those relating to impairment.

Managing poorly performing practitioners: The second domain in which medical boards are active is in managing poorly performing practitioners though a variety of disciplinary and non-disciplinary processes. It is in this area that there is the most variation in the approach of the various medical boards. In NSW, there are 25 000 registered doctors. Every year about 1200 complaints are made against them. Only 20% of these are formally investigated, and less that half of the investigations proceed to a disciplinary hearing. Each year, the NSW Medical Board holds 25–30 Medical Tribunals, with about half these doctors being deregistered. Contrary to popular belief, deregistration is the outcome for only about 1% of doctors about whom complaints are made.

Management of "impaired" practitioners: The third domain, and the most important in the context of this Conference, is the management of "impaired" practitioners. While the definition varies from State to State, a practitioner is generally considered to be impaired if he or she suffers from any physical or mental condition which detrimentally affects, or is likely to detrimentally affect, his or her capacity to practise medicine.

It is important to recognise that doctors and students may be unwell or disabled without being "impaired", according to its statutory definition. Impairment is very specifically related to risk to the public. For example, if a surgeon develops Parkinson's disease and gives up procedural practice, then he or she is clearly unwell, but not impaired. The single most important factor in determining impairment is the practitioner's insight into his or her illness and its effect on practising medicine.

The objective of impairment programs is, like all Board activities, to protect the public. However, a strong secondary objective is to maintain the doctor in safe practice whenever possible.

Conclusions

Medical boards discharge their responsibility for public protection in a variety of ways. The structured, compassionate and fair management of impaired practitioners is an important component of a board's work. The NSW Medical Board has 10 years' experience with student registration, and commends it to other jurisdictions, and to students themselves, as a valuable and mutually beneficial approach.

  • Alison M Reid1

  • New South Wales Medical Board, Gladesville, NSW.


Correspondence: nswmb@doh.health.nsw.gov.au

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