Australian Health Practitioner Regulation Agency (AHPRA) was established on July 01, 2010, as part of the National Registration and Accreditation Scheme (NRAS), with the purported role of protecting the public by regulating healthcare practitioners (HCPs) over multiple disciplines. Over the last 15 years, it has evolved into a behemoth and it now presents an extraordinary challenge for Australia’s healthcare providers and consumers. Trust in AHPRA is dropping at an extraordinary rate.

Interestingly, AHPRA was not formally established by the Australian Constitution (i.e., there is no constitutional mandate); rather, it was created through an agreement between the governments of the Commonwealth and the states and territories which adopted the Health Practitioner Regulation National Law (The National Law). This law provides the legal framework for AHPRA’s functions

There is now widespread opinion that AHPRA has increased in bureaucratic function; and, based on multiple examples of it employing unorthodox approaches, has a self-appointed remit beyond its intended purpose – with chilling effect to the 850,000 HCPs (of which 15 per cent are doctors and over half are nurses) being handled with relative impunity. At the heart of this is the incompetence of investigators who, very simply, frequently misinterpret the subtleties of doctor-patient interactions and seemingly subscribe to the upside-down tenet that a ‘HCP must be guilty until innocence is proven’. Are these investigators drunk on power or forced to meet arbitrary targets? Probably both…

Consequently, many have even started to openly question if AHPRA is fit for purpose, with some exploring the feasibility of an alternative registration body where the senior staff are elected and not selected. If the political will were present and given the demand from stakeholders; it is likely that competition to the regulation of doctors, for whom practice is hugely more complex and nuanced than for other disciplines, would result in superior delivery of regulation and outcomes.

In the meantime, what is clear is that the significant problems with AHPRA need to be addressed. AHPRA’s responsibility revolves around the registration of healthcare practitioners and managing their professional standards, which includes complaints handling. However, innumerable practitioners who are medical and paramedical (such nurses and dentists), along with lawyers, journalists, patients, and other critics, have argued that AHPRA has sequentially exerted disproportionate ‘control’ over the last decade. Indeed, the last few years in particular, have highlighted the stymying of considered individual opinion, stifling of dissent, and the gross undermining of professional autonomy for doctors in particular, at the hands of AHPRA’s administrative staff who, frequently, have neither medical nor legal backgrounds.

Overstepping of operational scope covers the following 10 domains:

1. Disciplinary actions which are excessive and where standards have been applied heterogeneously.
2. Influence on clinical judgment, where guidelines are sometimes enforced as algorithmic requirements, with the resultant rigidity impeding nuanced, patient-specific decision-making with blunted empathetic practice.
3. Punitive measures with the punishment being the process even for unsubstantiated, frequently vexatious, complaints, which many believe to be related to AHPRA hitting its key performance indicators (KPIs).
4. Erosion of critical thinking, free speech, and scientific debate; fostering a culture of surveillance and suspicion.
5. Weaponisation of ‘experts’, who then engage in sham peer review, to restrict innovative practices which are logical in nature, due to the fear of regulatory repercussions.
6. Deterrence of patient advocacy if contrary to the winds of populist thought which are propagated by mainstream media.
7. Inappropriate intervention into commercial decisions unrelated to patient care.
8. Adverse impact on practitioner wellbeing with increased psychological morbidity and mortality (suicide), and the wider impact on the practitioner’s family members due, primarily, to financial distress.
9. A culture of fear leading to the destruction of professional collegiality.
10. Destruction of public confidence by, ironically, undermining the public’s trust in the ethics and processes of health care in Australia.

Whilst regulation is essential for maintaining professional standards and protecting patients, it must be balanced against the need for professional autonomy and innovation which is ethically delivered in the absence of fear. Accordingly, reforming AHPRA’s governance structures must include:

1. Increased representation by practitioners who, additionally, are elected.
2. Regular audits of AHPRA’s operations, along with transparent, independent reviews of AHPRA’s activities.
3. Widely publicised, meaningful processes for complaining against AHPRA.
4. Regular publishing of data from the National Health Practitioner Ombudsman (NHPO).
5. Personal accountability of AHPRA’s employees who fail to act in good faith.

Every reasonable HCP would agree that a regulatory body is de rigueur, but with great power comes great responsibility. Per AHPRA’s own statistics, a double-digit number of HCPs have committed suicide under the shadow of investigation therefore, it is incumbent upon us all to demand an end to the institutional arrogance which underpins the persecutory and arguably predatorial nature of AHPRA.

The restoration of fairness and trust has unmatched implications for the wellbeing of practitioners and the public. This is not only necessary, but urgent, in order to ensure that Australia’s health-care system may return to being a bastion of excellence and compassion. Lives, quite literally, depend on this.

Dr. Niro SIVATHASAN, BSc, MB BS (Lond), DRCOG, MRCS (Eng), AFACP, DU (Plast), FCPCA, FACAM, FACCSM (Med), FACCSM (Surg), FAACS.

International Medical Doctor and State Secretary for Australian Medical Professionals Society (A.M.P.S.)