We have a concerning situation regarding older doctors who wish to give up full time practice but who want to continue to contribute to the profession as ‘senior active’ doctors. I have written a proposal below that addresses this issue. I would be very grateful for your support for this proposal, or if it is not acceptable in its current form, I would appreciate you suggesting changes that would meet with your approval.
Medical careers, like the human life cycle, have a start, a middle phase, and a finish. Following a prolonged gestation of training, practitioners move on to their general practice or specialist disciplines and provide clinical care to patients, education and training to junior colleagues, and administrative support to hospitals and other medical organizations over decades of hard work. At some stage the doctor starts to think of slowing down, or contemplates full retirement. These days we know that moving from full time practice to full retirement in one step is not a good thing – for the practitioner’s physical health and mental health, and not for the profession either. Government policy is to encourage older workers and professionals to stay in the workforce longer, beyond current retirement age if possible.
Yet, despite this encouragement for older professionals to remain active in their field, in the medical arena we have a situation that is hostile to this happening. The new Medical Board of Australia (MBA) has no registration category that allows older doctors to remain registered after giving up full time general or specialist practice. Older doctors are forced to go straight into full retirement. They are prevented from continuing to practice in a limited capacity as a doctor. This situation denies senior doctors the advantages of a graduated progression to retirement. It also means that these doctors cannot use their accumulated medical knowledge, skills and wisdom for suitable work such as teaching, examining, mentoring, tutoring, assisting with tribunals, and advising government, non-government, voluntary and private/business organizations on medical matters, as well as being a body of registered practitioners available to assist in times of local, state and national disasters. This denies the community a precious medical resource that otherwise would be available.
It is time this gap was filled. A new category of medical registration – termed ‘senior active’ – needs to be developed by the MBA.
I propose the following model for the ‘senior active’ category. The description is based on the MBA Limited Registration – Public Interest category (MBA Registration Transitional Plan – Medical Practitioners – Item 17, 30.6.10).
1. Senior active registration would be a limited class of registration, but it would have unlimited duration.
2. The doctor would remain on the register of medical practitioners.
3. The doctor could participate in activities (either remunerated or as a volunteer) that use his or her medical knowledge, skills or wisdom outside the care of individual patients such as teaching, examining, mentoring, tutoring, assisting with tribunals, and advising government, non-government, voluntary and private/business organizations on medical matters, as well as being available to assist in times of local, state and national disasters.
4. The registrant may, without fee or reward, refer an individual to another medical practitioner (in fully registered medical practice) for the purposes of providing health care. The registrant may, without fee or reward, prescribe a therapeutic substance in extenuating or emergency situations under the following conditions: (a) the prescription involves the renewal of a prescription provided by another medical practitioner (in fully registered medical practice) within the previous period of six months and does not relate to a drug of addiction within the meaning of the relevant Poisons act, or (b) the prescription is provided to an individual who requires temporary relief or first-aid pending attendance on that individual by another medical practitioner (in fully registered medical practice), and (c) if the registrant undertakes limited prescribing as outlined in (a) and (b) above, the registrant must, within a 12-month period preceding the date on which the prescription is prescribed, have undertaken professional education activities relating to the prescribing of therapeutic substances.
5. Maintenance of this category of limited practice would require an annual medical check by a general practitioner for registrants over the age of 80 years.
A category of this nature would allow senior doctors to continue to contribute to the profession after leaving full time general or specialist practice. This would be good for senior doctors, the profession, and the community.
This category allows doctors the limited capacity to refer individuals to other medical practitioners, and a limited capacity to prescribe therapeutic substances. It is possible that the doctor could exercise discretion and use this limited capacity to prescribe for him or herself, or for immediate family. This level of discretion is available to all doctors in fully registered medical practice despite the general advice from the AMA and medical boards that doctors should not treat themselves or their immediate family except in emergency or extenuating circumstances. Given the limited nature of referral and prescribing allowed in the senior active category, and the requirement to undertake relevant professional educational activities in prescribing, I cannot see any reason to deny this discretion to senior active doctors. To do so would raise the question of age discrimination.
In my view the success of the category will depend on how restrictive the practice definition is and how much it will cost doctors to be registered in this category. The three major costs for this category will be the medical board registration fee, the indemnity insurance fee, and professional education expenses. If the total of these can be kept within reason (say well below $500pa) then the category may be an attractive place for senior doctors to maintain their registration after leaving full registration status in their discipline and before moving to full retirement.
Comments would be appreciated.
Congratulations on launching your new website, Philip.
The cost for maintaining registration when practice is limited to the unremunerated writing of referrals with the report to go to a fully registered medical practitioner and writing repeat prescriptions should be well below $500. For about 10 years in Qld before the beginning of AHPRA/MBA, doctors could remain on the register without registration fee if they had not practised medicine for remuneration during the previous 12 months. There is no known example of complaints lodged with MBQ from this type of registration during this period.
Regular consultation with the doctor’s GP or specialist is, in my opinion, sufficent CPD for the writing of repeat prescriptions. This also should satisfy the requirements of recency of practice.
The annual cost of professional indemnity insurance with MDA for this type of unremunerated practice is $317.47. I reckon that, even at this cost which is well below AVANT, for example, they are making a comfortable profit as the risks are negligible.
I agree with most of your points, but a couple of need to be discussed further, I will hold a small talk with my partners and maybe I will look for you some suggestion soon.
Some genuinely great blog posts on this internet site , thankyou for contribution.
Merely a smiling visitant here to share the enjoy (:, btw outstanding pattern .
OOPS. I included the cost of initial membership of MDA which is $259.23 inc GST. The total annual premium is a very reasonable $58.24 inc GST, stamp duty and ROCS Support Payment
I think your suggestion is very good, particularly with regard to referrals, which can be very useful and save both waiting time and uneccessary burden on busy GPs, particularly where, e.g., regular routine checks by specialist colleagues are recommended for frail elderly people.
It can also help in an emergency by avoiding lengthy waiting periods in Emergency Departments when, for example it is obvious to an experienced doctor that an injured hand requires urgent exploration and treament by a hand surgeon.
But how about the opportunity to order basic XRays, perhaps to avoid an unnecessary visit to Emergency, by excluding bony injury? Or to order simple or repeat pathology tests, to facilitate referral? Definitely NOT to initiate treament, but just to save time and cost.
I do think your suggestion for prescribing is rather too limited, however. What is a real emergency, and how to define extenuating? What about the situation where a friend or relative is in the process of developing ophthalmic herpes zoster, on a weekend, in a country town with no doctor? And when there have been no recent lectures on herpes zoster in particular? Or when travelling, or where someone has lost a vital drug or repeat prescription…Or, as happened to me, a doctor encounters a passenger developing anaphylaxis in-flight? Initiating treatment can be life-saving.
I am greatly troubled by the thought that when I retire I will not be legally able to practise even as a Good Samaritan, because there are some things and skills which a doctor who is reasonably alert never forgets, and how can we stand by and not help?
I favour the ADF proposal of graded privileges for doctors who are keen to follow the requirements for adequate CPD and indemnity, but who no longer wish or have the opportunity to “work” in the medical field.
Keeping a fresh blog is difficult and quite tiresome. You might have pulled it off well though.
You know i dont usual comment, but i truly like your blog and i thought i would introduce myself. I have been reading it for awhile but this is my initial comment.
Thanks for giving the bog a go! Philip.
Wow you have performed it once more. Some excellent info here. You’ve made me break my comment embargo, cheers 🙂
I’m going to be sincere here: this post is fantastic! I discovered a bunch of new, fascinating information. If you could show me your newsletter link
I am sorry but I do not have a newsletter. However, the Gold Coast Medical Association (I am a member) has a newsletter – The Medical Link. Google Gold Coast Medical Association and follow their links to the newsletter. Philip Morris.
I hardly comment, however i did sopme searching and wound up here ‘Senior
Active’ Medical Practitioner Registration or Transition to Retirement Registration – Dr Philip Morris.
And I do have 2 questions ffor you if you don’t mind. Could it
be just me or does it give the impression
like a few of the comments appear like they are coming from brain dead visitors?
😛 And, if you are writing at other social
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Could you list of the complete urls of your shared sites like your twitter feed,
Facebook page or linkedin profile?
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blog, Keep up the pleasant job.
Thanks for your comment.