Doctor wellbeing

Practices associated with humiliating medical students persist in contemporary medical education, more commonly in subtle than overt forms

Karen M Scott PhD, MA, BEd · Patrina HY Caldwell BMed, FRACP, PhD · Elizabeth H Barnes MStat, BAppSc · Jenny Barrett DEd, MEd, BA

ObjectivesTo assess the prevalence, characteristics and outcomes of health impairment notifications to the Australian Health Practitioner Regulation Agency (Ahpra) and to assess the influence of doctor age, sex, specialty, practice location and country of training on the incidence of health impairment notifications.Study DesignRetrospective cohort study; analysis of linked de-identified Ahpra medical register and health impairment notifications data.Setting, ParticipantsAll doctors registered to practise in Australia (except New South Wales) for whom notifications of concerns about physical or mental illness, cognitive decline, substance use disorder or other impairment to safely practising medicine were received by Ahpra during 1 July 2012–30 June 2022.Main Outcome MeasuresHealth impairment notifications, overall and by notification type and specialty; influence of doctors' characteristics on the incidence of notifications.ResultsDuring 2012–2022, 112,677 doctors were registered to practise in Australia (other than New South Wales). A total of 1732 health impairment notifications were recorded, including at least one notification for 1258 doctors (1.1%). In multivariable analyses, the incidence of health impairment notifications was higher for male than female doctors (adjusted incidence rate ratio [aIRR], 1.45; 95% confidence interval [CI], 1.26–1.67), for doctors aged 70years or older than for those aged 30–39years (aIRR, 2.92; 95% CI, 2.30–3.70) and for doctors in regional (aIRR, 1.33; 95% CI, 1.12–1.58), rural (aIRR, 1.27; 95% CI, 1.03–1.57) and remote areas (aIRR, 1.55; 95% CI, 1.03–2.33) than in metropolitan areas. Among doctors with specialist qualifications, the incidence of notifications was higher for psychiatrists than internal medicine physicians (aIRR, 2.28; 95% CI, 1.62–3.21) and the incidence of substance use notifications was highest for anaesthetists (vs. internal medicine physicians: aIRR, 2.83; 95% CI, 1.66–4.83). Compared with doctors who trained in Australia, doctors who trained in non-comparable jurisdictions were less likely to be subjects of health impairment notifications (aIRR, 0.53; 95% CI, 0.43–0.64). Of 1708 notifications with final Ahpra determinations, 367 (21.5%) resulted in practice restrictions or removal from practice.ConclusionsHealth impairment notifications are infrequent but can have serious consequences for doctors. The incidence of health impairment notifications is influenced by doctor age, sex, specialty and location. Specific measures that take these factors into account could support workplace health and safety for doctors and protect patients from harm.

Marie M. Bismark, Dilanka Hettiarachchi, Martin Fletcher, Owen Bradfield, Anu Tayal, Yamna Taouk