Bullying and harassment in the Australian medical profession
There has been considerable focus in the Australian community in recent years
on the issue of workplace bullying and harassment in the medical profession. A
series of reviews and reports have indicated that bullying and harassment is a
significant problem across a wide range of practice types and regions.
On 2 February 2016, the Senate referred the medical complaints process
in Australia to the Community Affairs References Committee for inquiry and
report, with the following terms of reference:
the prevalence of bullying and harassment in Australia’s medical
any barriers, whether real or perceived, to medical practitioners
reporting bullying and harassment;
the roles of the Medical Board of Australia, the Australian Health
Practitioners Regulation Agency and other relevant organisations in managing
investigations into the professional conduct (including allegations of bullying
and harassment), performance or health of a registered medical practitioner or
the operation of the Health Practitioners Regulation National
Law Act 2009 (the National Law), particularly as it relates to the
complaints handling process;
- whether the National Registration and Accreditation Scheme, established
under the National Law, results in better health outcomes for patients, and
supports a world-class standard of medical care in Australia;
the benefits of 'benchmarking' complaints about complication rates of
particular medical practitioners against complication rates for the same
procedure against other similarly qualified and experienced medical
practitioners when assessing complaints;
the desirability of requiring complainants to sign a declaration that
their complaint is being made in good faith; and
any related matters.
Guidance on terms of reference
The committee subsequently published additional guidance on the
inquiry's terms of reference, highlighting that the inquiry's focus was on the
intersection between bullying and harassment in Australia's medical profession
and the medical complaints process:
To guide the inquiry process, the committee would like to
provide clarity on how it is interpreting the terms of reference (ToR). The
overarching issue under inquiry is the prevalence of bullying and harassment
within Australia's medical profession (ToR a).
The other ToR should be read according to how they relate to
bullying and harassment within Australia's medical profession, and how such
bullying and harassment may ultimately impact on individual medical
practitioners and patient outcomes.
That guidance further added the following additional notes on individual
terms of reference:
ToR a This is the overarching issue
under inquiry. The committee defines 'Australia's medical profession' as
including both nurses/midwives and medical practitioners (doctors), as well as
students for those professions.
ToR b Is there anything
preventing medical practitioners from reporting bullying and harassment?
ToR c Are the complaints and
investigation processes of the relevant medical boards, nursing and midwifery
boards and AHPRA able to be used vexatiously for bullying or harassment,
particularly by other medical professionals?
ToR d Does the legal framework
under which the relevant medical boards and AHPRA operate have appropriate
safeguards against being used vexatiously for bullying or harassment?
ToR e Has nationalising the
registration and monitoring of medical practitioners improved medical care in
ToR f Should there be
stronger requirements for patient outcome specific data to be used both in
lodging and investigating complaints?
ToR g Is there evidence to
suggest vexatious complaints are being made, and if so, what systems could be
put in place to reduce the prevalence?
The issue of bullying and harassment in Australia's medical profession
received concentrated public and media attention following a series of
prominent doctors making public comments about the profession's culture. Most
notably, vascular surgeon Dr Gabrielle McMullin described the sexual harassment
of female doctors as rife within the profession,
and neurosurgeon Dr Charlie Teo noted that bullying is 'more extreme than
you've been led to believe'.
The committee notes there have been a number of recent inquiries into
workplace bullying and harassment in Australia. Notably, the House of
Representatives Standing Committee on Education and Employment inquiry into
workplace bullying in 2012 highlighted that bullying was a significant issue
across a range of industries and professions.
A 2015 report by the Expert Advisory Group established by the Royal
Australasian College of Surgeons (RACS) found that 'discrimination, bullying
and sexual harassment are pervasive and serious problems in the practice of
surgery in Australia and New Zealand'.
The Australian Medical Association (AMA) suggests that the findings of
the RACS survey are likely to be representative across the whole medical
profession, suggesting 'anecdotal evidence and feedback from members would
indicate that this experience is replicated in other medical specialties'.
As the submission from mental health advocacy group Beyondblue notes,
the effects of workplace bullying and harassment can be serious and
wide-ranging, particularly in the medical profession:
Research shows a clear link between bullying and harassment
and the experience of depression and anxiety conditions. These conditions are
potentially disabling, and associated with a wide range of adverse outcomes for
affected individuals, including the risk of premature death by suicide. These
conditions also impact on family, friends, workplace colleagues, and on society
Bullying can lead to poor health and low morale, engagement
and productivity among workers who witness bullying. In the medical profession
the negative impacts of bullying and harassment have the potential to impact on
Focus of the inquiry
This inquiry was established to investigate the role of the existing
medical complaints process to deal with certain types of bullying and
harassment. A focus for this inquiry was how the medical complaints process in
Australia, overseen by AHPRA and the National Boards, has itself been misused
by some medical practitioners as a form of bullying and harassment. The
committee has also investigated broader questions of bullying and harassment
within the profession, including its prevalence and barriers to the reporting
Throughout this inquiry, the committee received examples of medical
practitioners whose careers and lives have been affected by what they believe
are vexatiously made complaints lodged against them by colleagues or
While concerned about the prevalence of a wide range of forms of
bullying and harassment within Australia's medical profession – and the
consequent effects that has on patient outcomes and public safety – the
committee's focus in this inquiry has largely been on the misuse of the
complaints process. The medical profession needs a robust, transparent and
respected complaints process in order to ensure public safety.
National regulation and accreditation of medical practitioners
Australia's medical complaints process is a consequence of the creation
of a national scheme for the regulation and accreditation of medical
practitioners. In 2006, the Productivity Commission recommended the
establishment of a single national registration and accreditation scheme (NRAS)
to enable the Australian health workforce to deal with shortages and associated
pressures; to increase its flexibility, responsiveness, sustainability and mobility; and to reduce red tape.
The Council of Australian Governments (COAG) agreed in 2006 to establish
the NRAS, to ensure that all health professionals were 'registered against the
same, high-quality national professional standards' and to allow 'doctors,
nurses and other health professionals to practise across state and territory
borders without having to re-register'.
the Intergovernmental Agreement for a National Registration and Accreditation
Scheme for the Health Professions in 2008. The scheme consisted of 'a
Ministerial Council, an independent Australian Health Workforce Council, a
national agency with an agency management committee, national
profession-specific boards, committees of the boards, a national office to
support the operations of the scheme, and at least one local presence in each
state and territory' (see Figure 1.1).
Figure 1.1 – National Registration and Accreditation Scheme
Health Practitioner Regulation Agency.
Department of Health outlined the objectives of the National Scheme, as set out
in the establishing legislation:
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 workforce mobility
across Australia by reducing the administrative burden for health practitioners
wishing to move between participating jurisdictions or to practise in more than
one participating jurisdiction;
to facilitate the provision of
high quality education and training of health practitioners;
to facilitate the rigorous and
responsive assessment of overseas-trained health practitioners;
to facilitate access to services
provided by health practitioners in accordance with the public interest; and
to enable the continuous development
of a flexible, responsive and sustainable Australian health workforce and to
enable innovation in the education of, and service delivery by, health
As the Commonwealth does not have the power to regulate health
professionals, the legislative framework for implementation of the NRAS was
enacted by the state and territory legislatures.
The Health Practitioner Regulation National Law Act 2009 (Qld)
(National Law) received Royal Assent on 3 November 2009. It details the
substantive provisions for registration and accreditation. Other states and
territories passed similar legislation to the National Law and
jurisdiction-specific consequential and transitional provisions.
The NRAS legislation replaced 65 Acts across the jurisdictions and the bodies
established replaced 80 state and territory boards. Several jurisdictions made
amendments to the National Law, including New South Wales which opted for
retaining its own complaints system. As the NRAS is based on state and
territory legislation, the Commonwealth has limited capacity to modify
The NRAS commenced on 1 July 2010 for all States and Territories except
Western Australia, which joined the NRAS on 18 October 2010.
Improving health outcomes and
The NRAS was originally recommended as a productivity measure by the
However, in implementing the scheme, COAG emphasised the scheme's purpose in
protecting health consumers and stated:
The new scheme will deliver many benefits to the Australian
community including health consumers. National standards in each profession
will mean stronger safety guarantees for the community. Patients will know that
wherever the health professional is from, they are registered against the same,
high-quality national professional standards.
As the Department of Health noted, the NRAS is one element of
Australia's health system, but it does have particular responsibility for the
protection of the public:
This Scheme for the first time initiated nationally
consistent standards for the registered professions, provided mobility for
professionals to work across jurisdictions and allowed the development of a
national public register of registered health professionals.
From the perspective of the Medical Board of Australia, the Nursing and
Midwifery Board of Australia and the Australian Health Practitioner Regulation
Authority one of the National Scheme's notable achievements is improved outcomes
for patients via greater public protection:
... a national on-line register of practising practitioners and
cancelled health practitioners which can be accessed by the public at any time,
and prevents health practitioners who have committed misconduct and faced
regulatory action to practise undetected in other states or territories.
Creation of the Australian Health
Practitioner Regulation Agency
The Australian Health Practitioner Regulation Agency (AHPRA) was
established as the national agency responsible for implementation and ongoing
management of the NRAS, and currently oversees 14 professions, including
medical practitioners and nurses/midwives. The 14 National Boards currently
part of the NRAS are:
Aboriginal and Torres Strait Islander Health Practice Board of
Chinese Medicine Board of Australia;
Chiropractic Board of Australia;
Dental Board of Australia;
Medical Board of Australia;
Medical Radiation Practice Board of Australia;
Nursing and Midwifery Board of Australia;
Occupational Therapy Board of Australia;
Optometry Board of Australia;
Osteopathy Board of Australia;
Pharmacy Board of Australia;
Physiotherapy Board of Australia;
Podiatry Board of Australia; and
Psychology Board of Australia.
AHPRA has the
maintaining up-to-date and publicly accessible national lists of
accredited courses and registered practitioners with entries relating to
individuals to include any conditions or restrictions on professional practice;
administering the resources of the scheme and ensure the scheme
is as efficient as possible;
acting in accordance with any policy directions from the
reporting annually to the Ministerial Council;
following agreement with the boards, setting fees, and where
there is no agreement, referring this to the Ministerial Council;
at its discretion, contracting or delegating functions, excluding
registration and accreditation functions, with any delegations reported to the
in consultation with the boards, developing and administering
procedures and business rules for the efficient and quality operation of the
registration and accreditation functions and the operation of the boards and
their committees, consistent with ministerial policy direction and the objects
of the legislation;
in accordance with the objects of the legislation and any policy
directions of health ministers, set frameworks and requirements for the
development of registration, accreditation and practice standards by the
national boards to ensure that good regulatory practice is followed;
advising the Ministerial Council on issues relevant to the
establishing a national office.
National Boards and the regulation
of individual practitioners
There is a National Board for each of the 14 regulated health
professions. National Board
members are appointed by the Ministerial Council. At least half, but not more
than two thirds of National Board members must be practitioner members and the
remaining members are appointed as community members to ensure a degree of
oversight from people outside the profession. Members of State and Territory
Boards (Professional Boards) are appointed by the Minister for Health in each
jurisdiction, with the same requirement for ratios of community members.
The functions of the Boards focus on protecting the public and guiding
the professions. This includes responsibilities for registering health
practitioners who meet the requirements of approved registration standards,
investigating and managing concerns (known as notifications) about the
performance, health or conduct of practitioners and developing standards, codes
and guidelines. National Boards have delegated many functions to AHPRA and
Board committees (national or State and Territory or regionally-based) to
support the efficient functioning of the National Scheme. Registrations and
complaints procedures are delegated from the National Board to the relevant
state or territory Boards.
Reviews of the NRAS
2011 Senate Finance and Public
Administration References Committee inquiry
In June 2011, just under a year after the NRAS took effect, the Senate
Finance and Public Administration References Committee reported on its inquiry
into the administration of health practitioner regulation by AHPRA. That report
acknowledged the scale of the undertaking, but highlighted that implementation
of the NRAS had been problematic.
The committee wrote:
The committee points to the impact on patients and health
service provision as yet another example of the serious implications of AHPRA's
administrative failures. The committee notes that it has exacerbated patient
waiting times, and compromised health service provision, particularly in rural
and remote communities which are already particularly vulnerable.
The committee made ten recommendations, including one relevant to this
The committee recommends that complaints processing within
AHPRA be reviewed to ensure more accurate reporting of notifications and to
reduce the impact of vexatious complaints on health practitioners.
2014 Independent review
In 2014, the National Scheme was reviewed by an Independent Reviewer, Mr
Kim Snowball. The final report of this review was published in 2015 and made 33
recommendations. The Australian Health Workforce Ministerial Council accepted
the two recommendations specifically related to AHPRA's notification and
The first of these, Recommendation 9, concerned increased and improved
communication from AHPRA to both the notifier and the medical practitioner,
including establishing the notifier's expectation for matters referred to a
National Board. The Ministers asked AHPRA to 'action this recommendation as a
matter of priority and provide a progress report by December 2015'.
Recommendation 28 was that AHPRA should, in consultation with the
National Boards, Tribunals and Panel members, conduct specific education and
training programs for its investigators, with the aim of developing 'more
consistent and appropriate investigative standards and approaches... including
the primacy of public safety over other considerations within the matters'.
The ministerial council accepted this recommendation and requested a progress
report from AHPRA by December 2015.
In their submission, the Medical Board, Nursing and Midwifery Board and
AHPRA recognised that:
... the management of notifications and complaints has not
always met community expectations, including concerns about delays in the
management of some notifications and confusion in roles with partners such as
the health complaints entities.
Consequentially, they have been working to improve the process,
particularly in terms of timeliness and communication. They identified three
main areas in which improvements were being made:
implementing processes that
deliver early triage of notifications and greater clinical input to ensure we
continue to improve the timeliness of assessment of notifications;
working with health complaints
entities to ensure roles and processes are as clear as possible for notifiers and
practitioners. A common assessment matrix has been developed and agreed to
determine which entity is best placed to manage each matter and public
information has also been produced; and
correspondence with notifiers and
practitioners has been reviewed and improved and more meaningful progress
reports are now being provided to notifiers and practitioners during the course
Conduct of the inquiry
The inquiry was referred to the committee on 2 February 2016, with a
reporting date of 30 June 2016 set.
It lapsed with the dissolution of the 44th Parliament on Monday
9 May 2016 and was re-referred by the Senate on 15 September 2016.
A new reporting date of 16 November 2016 was set, but was subsequently extended
until 30 November 2016.
Handling of submissions
The committee invited submissions to be lodged by Friday 13 May 2016. Following
the inquiry's lapse and re-referral, the committee decided not to formally call
for further submissions but continued to accept submissions.
In total, the committee received 129 submissions from individuals and
organisations. A list of submissions to the inquiry is available at Appendix 1.
The committee received a number of submissions from individual medical
practitioners, as well as from family members or others on their behalf,
discussing their personal experience of bullying and harassment, including via
the complaints process. The majority of these submissions provided detailed
accounts of individual cases.
To respect the privacy of those submitters, as well as of other medical
practitioners, patients and employees of the health system, the committee
decided to accept all such submissions in confidence. While individual cases
and examples will not be referred to in this report, the committee acknowledges
the concerns expressed by those who made submissions to this inquiry. These
submissions assisted the committee to gain a firsthand understanding of the
issues involved – the ways in which the complaints process has been implemented,
concerns about AHPRA's management of the assessment and investigation process
and the effects on practitioners' careers and lives as a result.
The committee also held two public hearings: one in Sydney on 1 November
2016 and a second in Canberra on 22 November 2016. Transcripts of those
hearings are available on the committee's website and a list of witnesses who
gave evidence is provided in Appendix 2. The committee acknowledges and thanks
all those who contributed to this inquiry by providing written submissions or
appearing at the public hearings.
Structure of this report
Following this introductory chapter, this report consists of three
Chapter 2 outlines the medical complaints process in Australia, discussing
the process of assessing and investigating complaints – known as notifications
– lodged against medical practitioners and how vexatious complaints are dealt
with. It then discusses concerns with this process, specifically in relation to
its relationship to bullying and harassment. In particular, this chapter draws
on evidence the committee received which suggests that the complaints process –
the making of a notification and the investigation by AHPRA and other bodies – can
be itself used as a tool of bullying and harassment within the profession. The
chapter then discusses the ramification of this, including its negative impacts
on practitioners' careers and lives and consequences for patient safety.
Chapter 3 addresses broader questions of bullying and harassment in
Australia's medical profession, including the responses to these made within
the profession itself.
Chapter 4 discusses the broader context of this inquiry, noting that
this inquiry into the intersection of the medical complaints process and the
prevalence of bullying and harassment within the profession has drawn the
committee's attention to systemic questions and concerns about the medical
complaints process in Australia as a whole. The chapter outlines areas the
committee considers to require further investigation that is beyond the scope
of this inquiry's terms of reference.
Navigation: Previous Page | Contents | Next Page