Revalidation: do doctors need it?
Doctors in future will have to undertake regular evaluations of their competence and fitness to practice that go beyond current accreditation, registration and continuing professional development (CPD) standards.
That was the underlying message from Medical Board of Australia Chair Dr Joanna Flynn and former New Zealand Health and Disability Commissioner Professor Ron Paterson at a forum on the controversial topic of doctor revalidation, held at the AMA National Conference.
The Medical Board has initiated discussion about the establishment of a system of revalidation amid the introduction of similar schemes overseas, most recently in the United Kingdom.
Dr Flynn and Professor Paterson made it clear they thought it would become increasingly untenable for the medical profession to rely on current accreditation, registration and CPD systems as a way to reassure the public of the competence of individual practitioners.
One of the issues proponents of some form of revalidation requirement for doctors have grappled with is to clearly identify the problem that such a process would be set up to address.
The forum was told that only a small proportion of doctors are the subject of formal complaints from patients or colleagues.
Dr Flynn said that of 95,000 registered practitioners in Australia, less than 5000 are the subject of complaints each year and, of these, only a small number are upheld and result in regulatory action.
Professor Paterson cited research showing that just 3 per cent of doctors are the source of 49 per cent of complaints.
But both said that the complaints system itself was not an effective way to ascertain the competence of a particular practitioner, with Professor Paterson pointing to evidence that several doctors who were the subject of multiple complaints continued to practice.
“There is an underbelly of problem doctors beyond those that come to the attention of the Medical Board and State and Territory Health Complaints Commissioners,” he said.
Professor Paterson said the public wanted reassurance that when they saw a doctor, they were not taking “pot luck” that the practitioner was fit to practice.
“We like to think that we are in the hands of capable doctors, but I don’t believe that the current self-declaration of having completed CPD gives me the same sense of assurance that I get with an airline pilot,” he said.
Dr Flynn admitted that the problem that a revalidation-style system would help solve was not yet defined.
But she was nonetheless confident that to maintain the trust of the public, the medical profession had to accept the need for a system that verified the competence of practitioners.
“We will need to do something beyond what we are currently doing,” Dr Flynn said, adding that claims that CPD programs provided sufficient assurance were unconvincing.
“Can you assure me that everyone who has done your CPD program is actually competent and practising at a reasonable standard?” she asked. “My sense is that, for most CPD programs, they don’t do that, or at least, not to a high enough level of certainty.”
As to what a revalidation program would look like, Dr Flynn was keen to emphasise the Medical Board had no preconceptions, and thought it unlikely to approximate the systems operating in the United States or the UK.
British Medical Association President Professor Sheila the Baroness Hollins gave an account of her own experience with the UK’s recently-introduced revalidation system, which requires doctors to provide six categories of supporting information.
These included CPD, reports on quality improvement activities and significant events, feedback from at least 13 patients and colleagues (with responses), and a review of complaints and compliments.
Professor Hollins said the process, while not particularly lengthy, might nonetheless “engage you in different types of activities, which might take some time”.
The AMA and the broader medical profession has expressed disquiet about the potential of revalidation to add to the administrative burden and costs of doctors with little demonstrable gain.
Dr Flynn said the Medical Board was cognisant of these concerns, and wanted to develop a system, in close consultation with the AMA and other representatives of the profession, that was of benefit to practitioners as well as patients.
She said that any test should be seen to have intrinsic worth for those undertaking it, that it be relevant to each doctor’s practice, that it be readily available and accessible, and that it not be burdensome.
Dr Flynn said it would most likely involve feedback from multiple sources, practice visits from peers, the use of practice data and, probably, some form of test.
“I think we need to do something. All of us as medical practitioners are weakened by poor standards of practise and the failure of our colleagues,” she said.
Video of this and other sessions of the AMA National Conference 2013 can be viewed online at https://ama.com.au/live
Published: 31 May 2013