Outcomes of notifications to health practitioner boards: a retrospective cohort study

Many countries entrust oversight of doctors and other health professionals to practitioner boards. A core mission of such boards is to protect the public from unsafe practice. Boards rely on patients, practitioners and their peers, employers and other agencies to bring risks to their attention and can employ a range of assessment and investigation processes to evaluate concerns about a practitioner’s health, performance or conduct. In cases where a practitioner poses a risk to patient safety boards can initiate a range of actions, including imposing conditions on the practitioner’s registration or suspending their licensure to practice. Actions that restrict ability to practice may have profound effects on affected practitioners – damaging livelihood, reputation, and potentially personal well-being [1, 2]. Imposing such actions therefore requires boards to chart a delicate course between protecting patients from harm and respecting the rights of practitioners [3].

Previous research has examined factors associated with disciplinary action against doctors. Studies have compared disciplined doctors with controls drawn from the broader medical workforce [4–7], with colleagues who were investigated or charged but not disciplined [8], and with colleagues who incurred less serious sanctions [9]. In general, these studies identify several risk factors for incurring disciplinary sanctions, including male sex, late career stage, and practice in certain specialties (surgery, obstetrics and gynecology, psychiatry, and general practice). In addition, longitudinal studies of doctors have shown higher rates of disciplinary actions among physicians who performed poorly during residency [10] and physicians who lack specialty certification [11]. Relatively few studies have focused these types of analyses on nurses [12–14], and fewer still have examined pharmacists [15], psychologists [16], dentists [17, 18], and other allied health professions. Moreover, this body of research tends to be profession specific. For example, no previous studies have directly compared doctors’ likelihood of regulatory action with risks experienced by other health practitioners.

In Australia, 14 health professions, including doctors, nurses, dentists, psychologists, and pharmacists, are regulated by a unified scheme that has operated since 2010. The scheme covers all states and territories, which creates a rare opportunity to use national, longitudinal data to examine the incidence and outcomes of “notifications of concern” (hereafter, “notifications”) relating to multiple professions [19]. We conducted a retrospective cohort study of all notifications received by the national agency over a 2 year period. We estimated the incidence of notifications among health practitioners and tested for associations between various characteristics of notified practitioners (e.g., age, sex, profession) and notifications (e.g., issue type and source of notification) and the adjudicated outcomes of these notifications, particularly restrictive actions.

Our goal was to advance understanding of how this key regulatory regime operates. We were particularly interested in generating information with the potential to facilitate efficient adjudication and guide prevention efforts. We hypothesized that there would be systematic differences in rates of notification between professions, and that there would be relatively high rates of restrictive action against practitioners from certain professions (e.g., psychologists) and for notifications about certain issues (e.g., drug or alcohol misuse).