ROLES AND RESPONSIBILITIES

OF PROFESSIONAL
REGULATORS


KATIE ELKIN



International Medical Graduates in
Australia

Medicine: A regulated profession









Protection
of the
public
Protection
of the
profession
Medicine: A regulated profession









Protection
of the
profession
Protection
of the
public
Interests of the
state
Wider public
interest
supply
distribution
Balancing the interests










The state The public The profession
Interests may coexist but public protection
(or public interest?) must be
paramount
Registration and training requirements must be set at the level
required to ensure public safety, and not at a higher level that
provides more economic benefits to the health professions than is
warranted
NZ Ministry of Health, 2012
Public protection vs public interest
Barriers to entry must not be set too high
Illegitimate benefit to the profession and its members
Drives costs up
May impact on supply
in order to meet the wider public interest

BUT ALSO

Barriers to entry must not be set too low
Impact on safety and quality
Public trust diminished
in order to ensure public protection
Public protection
Public interest
Public protection vs public interest (cont.)
Four interrelated and essential elements of the right
to health : UNESCO










Quality
Acceptability

Availability


Accessibility




It appears that in times of perceived workforce
shortage, considerations of workforce supply
may take precedence over issues of standards
with potentially adverse outcomes for patient
safety.
AMC submission, 2011:
Lost in the Labyrinth, 2012
Public protection vs public interest (cont.)
Responsibilities of Medical Boards and Councils

Regulatory functions as per relevant legislation
Mandate comes from that legislation
Functions to be exercised in accordance with that
legislation

Australia: pre-2010




Responsibilities of the Medical Boards and Councils
Australia: National Laws Act
Objectives (Pt 1, s 3) include:
to provide for the protection of the public by ensuring
that only health practitioners who are suitably trained
and qualified to practise in a competent and ethical
manner are registered
to facilitate access to services provided by health
practitioners in accordance with the public interest
to facilitate the rigorous and responsive assessment of
overseas-trained health practitioners



Responsibilities of the Medical Boards and Councils
Australia: National Laws Act (cont.)
Guiding principles (Pt 1, s 3) include that:
restrictions on the practice of a health profession are to
be imposed under the scheme only if it is necessary to
ensure health services are provided safely and are of an
appropriate quality.


Responsibilities of Medical Boards and Councils

Result of the National Laws Act
A legislative mandate to consider supply and availability
issues
Impact on range of decisions:



Simply a legislative expression of existing practices?

Registration
decisions
Ongoing
competence
decisions
Disciplinary
decisions
Responsibilities of Medical Boards and Councils

New Zealand: since 2004
Health Practitioners Competence Assurance Act
2003
In practice too, a more conservative approach to
IMG registration than in Australia
Despite even greater reliance on IMGs (43% cf
37%)




Balancing protection and supply
Have we got the balance
right?
How do we measure it?
Research
High profile scandals
Comments by regulators





Balancing protection and supply

Lost in the Labyrinth, 2012
Submissions
Recommendations
objective guidelines
workplace assessments
time in hospitals





Final word

it is my sincere hope that the reports
recommendations will help ensure that
those wishing to practice medicine and
call Australia home in future may do so
with certainty and clarity of what is
expected of them
Forward to Lost in the Labyrinth, 2012