'Impairment' is a term defined in the National Law.

A medical practitioner is considered to have an impairment if he or she has a condition that may detrimentally affect their capacity to practise medicine.

A medical student whose capacity to undertake clinical training is detrimentally affected by his or her health may also be considered impaired.

An impaired medical practitioner or medical student is usually the concern of the Council’s Health Program.

The Council's approach to an impaired practitioner will depend on the nature of the illness, the degree of insight displayed, any existing treatment program, and most importantly, any perceived risk to patients and others if the practitioner continues to practise.

Similar considerations apply to students who may have contact with the public in the course of their clinical training.

How does the Council address impairment in doctors?

Sometimes the Council receives a complaint or notification about a practitioner which indicates there may be a risk that the doctor is impaired in a way that could impact their capacity to practise. This article explains the role of a health assessor when impairment is considered a potential concern.

Who can attend a health assessment? Is this a disciplinary process?

Practitioners can be asked to see a health assessor when the nature of a complaint or notification suggests there is a risk of impairment. For example, a complaint or notification may indicate a practitioner’s lack of awareness that they are making clinical errors or repeatedly confusing patients which raise questions of possible cognitive impairment. A medical practitioner is considered to have an impairment under the law if they have a condition that may detrimentally affect their capacity to practise medicine.

Practitioners asked to attend a health assessment are not being punished and this is not a disciplinary process. Instead, the focus is on obtaining more information about the doctor, their health and their ability to work safely.

Who are health assessors?

A health assessor is an independent health practitioner who, on behalf of the Medical Council, makes an assessment of the existence, extent, and nature of the impairment.  A health assessor has a comprehensive understanding of the Council’s programs. The health assessor is not a treating practitioner for the doctor. All health assessors are specialists in their fields such as neuropsychologists, addiction psychiatrists and specialist psychiatrists, neurologists etc.

The role of the health assessor is to determine whether a practitioner has:

• a medical disorder, such as Major Depression; Substance Abuse Disorder; Bipolar Disorder etc which has the potential to impact on their practise
• any deficits in their cognitive performance
• insight into these issues
• appropriate supports in place, such as treating practitioners, and
• whether the type of work they perform has been modified to compensate for the presenting issue

These assessments are completed and compared with norms that reflect practitioners of similar age and training. The health assessor will provide a report to the Medical Council with their findings and recommendations for the Council to consider. A recommendation may be that the practitioner requires conditions on their registration in order to practise the profession safely e.g. to see a treating practitioner or to have regular drug or alcohol testing

What happens next? Can the Medical Council disagree with the health assessor's recommendation?

The health assessor will provide a report to the Council advising whether the practitioner is impaired under the definition of the National Law and if further action is needed to ensure public safety. It is important to note the health assessor does not make a decision to impose conditions. This is the role of the Council’s delegates who also look at all the information available to them regarding a practitioner.

Where the health assessor determines there is no impairment, the Council then considers whether any or no further action is taken.

The Council considers the health assessor’s report and recommendations in deciding whether to convene an Impaired Registrants Panel.

Where the health assessor determines there is no impairment, the Council then considers whether any or no further action is taken.

Impaired Registrants Panel Inquiry (IRP)

An Impaired Registrants Panel inquiry (IRP) is an inquiry where the practitioner meets with two to three Panel members to discuss the notification and the extent and nature of the impairment. The inquiry is also an opportunity for the practitioner to discuss the matter.  The inquiry generally takes three to five hours.

If the Panel agree the practitioner has an impairment, they may do any one or more of the following:

1. counsel the practitioner or recommend they undertake specified counselling;
2.  recommend that the practitioner agree to conditions being placed on their registration;
3.  recommend that the practitioner be suspended from practising medicine for a specified period;

 make recommendations to the Council as to any action that the Panel considers should be taken in relation to the matter.

If the Panel do not agree the doctor has an impairment, they will write a report for the Council to consider no further action or may recommend the Council refers the doctor to another stream, such as the performance stream.

What if I don’t agree to the conditions the health assessor proposes?

Conditions proposed are not mandatory for practitioners to accept as the health assessment is not a disciplinary process. However, these conditions may be proposed (at an IRP) with the intention of keeping patients and the public safe as well as assisting the practitioner in taking care of their own health.

If an impaired practitioner lacks insight and does not acknowledge the need for some limitation on his or her practice, it may be necessary for the practitioner to attend a hearing convened under s150 of the National Law. At this hearing, the Council’s delegates will decide if it is necessary to take immediate action to protect the public, through the imposition of conditions or even suspension of the practitioner.

What type of conditions may be placed on my registration?

The conditions placed on each practitioner are developed specifically for each individual situation, taking into account the concerns of Council and the type of work conducted by the doctor. However, broadly speaking, where a practitioner is experiencing a major depressive disorder, recommended private health conditions such as attending a treating GP and treating psychiatrist may be included. For practitioners with a substance abuse disorder, they may have conditions requiring them to undergo periodic drug or alcohol testing as well as public practice conditions.

Are health conditions placed on practitioners shared with others or made public?

The Law requires the Council to notify Ahpra of any conditions placed on a practitioner’s registration. Health conditions are not published on Ahpra’s register due to privacy concerns. The Law also requires the Council to notify employers of all conditions imposed on a practitioner’s registration. However, health conditions are not made available to any other third party.

What is the best advice for practitioners facing a health assessment?

Council hearing members, program officers and doctors who have been through this process all recommend that practitioners who receive a complaint or notification contact their Medical Indemnity Insurer (MII) early for support. Doctors who undertake the process with the support of their MII frequently find it less stressful as they approach the assessment from a more informed position.

It is also important to seek personal support if you need it. Talk with your family or a trusted friend about what is happening and how you are feeling, consult with your general practitioner, and consider using support services for information and assistance such as the Doctor’s Health Advisory Service, the Medical Benevolent Association of NSW, beyondblue and Lifeline.

The Council’s Monitoring Team proactively monitors practitioners who are in the Health Program to ensure they are complying with their conditions. This may include drug or alcohol testing, regular reviews or assessments. The practitioner is expected to comply fully with any conditions so as to assure the Council that they pose no risk to the public.

As the practitioner demonstrates evidence of progress in rehabilitation and recovery, the conditions on registration are gradually relaxed and/or removed. While a return to unconditional medical registration is a Health Program goal, a small number of practitioners, such as those with a recurring psychiatric illness, may remain on the program indefinitely. They will be regularly reviewed by the health assessor, the Impaired Registrants Panel and the Council.

If a doctor on the program is wilfully and continually in breach of conditions, the Council may convene urgent section 150 proceedings which can result in a tightening of conditions or temporary suspension.

The Council may also refer the doctor to the Health Care Complaints Commission for investigation, which can lead to a prosecution in the NSW Civil and Administrative Tribunal. The Tribunal has the power to cancel a doctor’s medical registration.

Dr X is a 60-year-old male GP who came to the attention of the Medical Council as a result of an investigation report by Pharmaceutical Services. The report indicated Dr X had written numerous prescriptions for pethidine in various patients’ names and that these prescriptions were for his own use.

In response, the Council initiated an urgent action to consider the need for immediate action under Section 150 of the National Health Regulation Law (NSW). As a result, the Council imposed a number of conditions on Dr X’s registration including that he be prohibited from prescribing, possessing and supplying any drug of addiction.

Dr X was also referred to an Impaired Registrants Panel which amended his conditions by requiring  him to submit to urine drug screening and to attend for regular treatment of his drug dependency.

Thereafter Dr X joined the Health Program. Dr X engaged well with the program and remained compliant with his conditions over several years. Dr X reported that his involvement with the program allowed him to make major changes to his life and overcome his drug dependency.

Dr X reported that the support he received on the program was very helpful and the formal structure allowed him to keep working as a GP and doing what he loves. Dr X successfully exited the Council’s Health Program approximately three years after the initial notification.

The Council adopts a non-disciplinary approach to impaired practitioners and is aware of the need to both facilitate and support appropriate treatment.

While the Council is not directly involved in the treatment of impaired practitioners, it may direct a practitioner to seek and comply with appropriate treatment as determined by their treating practitioner.

The Council’s goal when directing an impaired practitioner to maintain a relationship with their treating practitioner is to:

• ensure the practitioner is managing their health appropriately
• remove the need for the practitioner to self-prescribe and treat
• increase the practitioner’s insight of early warning signs of illness or relapse
• provide the practitioner with an important support network and strategies to address their health concerns

How will I know if I am nominated as a treating practitioner?

Generally, you will either be advised by your existing patient that they have a condition requiring they attend treatment with you, or the practitioner will seek treatment from you as required by their condition.

If you agree, the practitioner will provide your professional contact details to the Council. The Council will then write to you to provide further information about the conditions on the practitioner’s registration, the expectations of the role and the Council’s Health Program.

As a treating practitioner, the Council will provide you with regular reports concerning the practitioner’s progress in the Health Program.

What am I required to do as a treating practitioner?

The condition on the practitioner’s registration will define the extent of your engagement with the Council. However, generally treating practitioners are not required to give reports or engage with the Council on a regular basis.

Treating practitioners are expected to:

• be a registered health practitioner and if required by the condition, specialise in a particular field (e.g. general practitioner, psychiatrist or psychologist)
• be nominated by a current or prospective patient
• contact the Council immediately should the practitioner fail to attend for treatment, if treatment is terminated, or there is a significant change in health status, including a significant temporary change
• contact the Council if you are of the opinion the practitioner no longer requires treatment by you
• comply with mandatory reporting requirements which can be found here

The Council will not direct the frequency of treatment as this will be at the discretion of you and the practitioner. This model has been developed so as not to intrude on the therapeutic relationship between you and the practitioner.

Where do I get further information?

Further information about the Council’s Health Program and the role of the treating practitioner is available in the Health Program Handbook.

We are also available to answer any questions you may have by contacting us.