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The number of registered health practitioners grew by 7.7% this year, to 801,659. This is an increase compared to the 5.9% growth experienced in 2018/19.
The higher growth this year is due to the inclusion of 35,099 health practitioners on the COVID-19 pandemic response sub-register launched on 6 April. Some health practitioners are registered in more than one health profession. Without the practitioners on the pandemic response sub-register, 769,430 health practitioners across all professions were registered at 30 June. This is an annual increase of 3.4% and consistent with trends since the scheme began in July 2010.
Of the registrant base, 98.1% hold some form of practising registration. There are 77,755 dental practitioners, medical practitioners and podiatrists who hold specialist registration in an approved specialty (9.7% of total registrants). In addition, 23,039 practitioners hold endorsement to extend their scope of practice in a particular area because they have an additional qualification that is approved by the National Board (2.9% of total registrants). For more information, visit Ahpra's website, choose the relevant National Board, then click the ‘Registration’ tab.
This year, Aboriginal and/or Torres Strait Islander participation across the regulated health professions was 1.0%, which is the same as last year but well short of the 3.3% Aboriginal and Torres Strait Islander representation in the general population. Increasing participation in the registered health workforce is one of the goals of the Aboriginal and Torres Strait Islander health and cultural safety strategy.
All registrants in the Aboriginal and Torres Strait Islander Health Practice profession identified as being Aboriginal and/or Torres Strait Islander (it is a requirement for registration in that profession). The profession with the second highest representation was paramedicine, which had 1.6% of their workforce identifying as Aboriginal and/or Torres Strait Islander, followed by nursing and midwifery with 1.3%.
We continue to work with more than 130 education providers to improve the exchange of information and identify the status of students to ensure that information is accurate, particularly about students who may have completed or ceased their study.
This year, Ahpra received 81,437 applications, down 12.5% from 2018/19. We anticipated this reduction because, in the previous year, a large number of applicants applied for registration in the new nationally regulated health profession of paramedicine. In nearly all professions the number of new applications for registration increased this year. Of all practitioners applying for registration, 91.8% (74,792 applicants) sought practising registration. As a percentage of all applications received, there was a 4.4% increase in practitioners applying for non-practising registration when compared with last year.
The health practitioners on the pandemic response sub-register were not required to make a new application for registration as they were returned to the register automatically if they met the specified criteria and did not opt out, except Aboriginal and Torres Strait Islander Health Practitioners who opted in.
Ahpra made improvements to how people can apply for registration and now accepts online applications from:
Online applications not only improve the applicant experience, they also reduce the amount of manual data entry by staff to capture application details and contribute to improved timeliness of assessment processes.
There were 82,520 decisions made about applications for registration. Of these, 5.2% resulted in conditions being imposed on a practitioner’s registration, or a refusal of registration, in the public interest.
In March, the assessment of internationally qualified nurses and midwives (IQNM) changed according to the new model approved by the Nursing and Midwifery Board of Australia. The new process allows a nurse or midwife to determine, through a self-assessment process before lodging their application for registration, whether they may be eligible for registration.
The new model streamlines the IQNM registration application process. One of the main changes is that some candidates will be required to pass a multiple-choice examination and a behavioural component in the form of an objective structured clinical examination (OSCE), before applying for registration. These changes may result in the number of unsuccessful applications for registration received from IQNMs reducing.
The new assessment model and its implementation has been a significant piece of work over several years involving Ahpra staff and the Nursing and Midwifery Board of Australia working together.
The examinations held were held for the Pharmacy Board of Australia, Psychology Board of Australia and Medical Radiation Practice Board of Australia.
Ahpra administered the oral examination (practice) in October, February and June. Examiners assessed 1,777 candidates (pharmacy interns). Another 63 oral exam sessions were held throughout the year for practitioners holding limited or general registration with conditions on their registration requiring the completion of an examination in practice, or law and ethics.
Due to COVID-19, significant changes were made to the delivery of the exams in June. The exams are normally held face-to-face with examiner pharmacists in locations in each state and territory. With less than eight weeks’ lead time, the Pharmacy Board of Australia and Ahpra developed a model that enabled the exams to be held using virtual technology with everyone participating from home or their own location. Over the course of two days, 210 exam sessions were held.
A total of 873 candidates sat the national psychology examination. This exam is held quarterly at test centres in each capital city. Due to COVID-19, the exam in the last quarter was held via online supervision with each candidate being responsible for sourcing a suitable location to sit the exam.
In total 53 candidates sat the national medical radiation practice examination. This exam is held quarterly at test centres in each capital city. The exam in the last quarter was held via online supervision with each candidate being responsible for sourcing a suitable location to sit the exam.
Ahpra received the results of 77,677 domestic and international criminal record checks of practitioners and/or applicants for registration this year, a decrease of 19.2% since 2018/19. A reduction was anticipated because, in the previous year, there was a large number of applicants applying for registration in paramedicine.
Overall, 4.0% of the results indicated that the applicant had a disclosable court outcome. All disclosable court outcomes are assessed in accordance with the Criminal history registration standard, which is common across all 15 National Boards.
This year, having considered a disclosable court outcome:
Ahpra renewed registration for 693,751 practitioners across Australia. As with new applications for registration, National Boards may impose conditions on a practitioner’s registration or refuse renewal entirely.
Online renewal was once again widely accepted, with 99.4% of all eligible practitioners renewing their registration online (29,476 more practitioners renewed online in comparison to last year). Online renewals as a percentage of all renewals increased by 0.2%. This is attributed to both renewal campaign improvements and the take-up by new graduates who engage with online registration processes when they are first registered.
During the peak registration period for new graduates from 1 October to 31 March, we received 29,094 new graduate applications for registration (a significant 12.5% increase from the previous year). Of the new graduate applications received, 97.7% were made online.
To assist end-of-year new graduates to register, we initiated a communication campaign and identified appropriate pathways for key stakeholders to escalate urgent matters. We refreshed website information and developed fact sheets to help applicants understand the assessment process and avoid common mistakes. As the Australian Criminal Intelligence Commission strengthened its requirements for certifying identity documents, we developed communication materials to help new graduates and other stakeholders to understand the new requirements. These identity documents must be submitted correctly for us to conduct the required criminal history checks to satisfy eligibility requirements.
There have been some significant improvements to the average time taken to decide the outcome of an application from a graduate when compared to the previous year. The average time taken to decide the application, typically on receipt of a graduate list from education providers confirming qualification, was reduced to 10 days (down from 19 days in 2018/19). The average time to decide the outcome of the application from the date received by Ahpra was also reduced to 42 days (down from 61 days in 2018/19).
These improvements were the result of using dedicated staff during the new graduate campaign period and changing processes to support prompt communications with applicants to follow up any outstanding information needed to complete the application.
Ahpra also conducted the first ever ‘applicant experience’ survey of end-of-year new graduates, with 24,212 graduates invited to participate in the voluntary survey and a participation rate of 15.8% (3,834 respondents). Overall the feedback was positive with almost 80% of respondents satisfied with how their application was managed.
Most respondents commented favourably on the timeliness of their assessment, felt they were generally well informed about their application status, had positive interactions with our Customer Service team and found the process and website easy to understand. Those who reported a less positive experience have provided valuable feedback on areas we can improve, for example communication processes, which have been incorporated into the planning approach for the 2020/21 new graduate campaign.
During the nursing and midwifery renewal campaign, we made improvements to our application forms to help explain to practitioners when an adverse disclosure needs to be made. We also implemented a triage system to review adverse disclosures received from practitioners. This allowed us to identify high-risk applications needing further assessment, in contrast to low-risk applications that could be renewed without delay.
This year we will continue the work to help practitioners understand what they do and don’t need to tell us and why.
This year, there were 127 subscribers to the PIE service from government departments, public and private hospitals, healthcare businesses, pharmaceutical companies, medical insurers, and nursing and aged care agencies.
On a random schedule, Ahpra completed 2,099 audits of practitioners across all professions, excluding paramedics due to their relatively recent inclusion in the National Scheme. Of the completed audits, 91.0% of practitioners were found to be in full compliance with the registration standards being audited.
About 3.1% of those audited elected to surrender their registration, failed to renew their registration or changed their registration type to non-practising. Analysis of the circumstances of those practitioners demonstrates two clear groups: practitioners residing overseas, and those no longer practising but maintaining registration.
We analysed the audit outcomes to better understand why non-compliance occurs. In some professions, practitioners were not always fully aware of specific requirements for continuing professional development. This continues to be addressed through increased communication about what is required to comply with professional development standards.
Of the practitioners found to be non-compliant, 74.4% of cases resulted in some form of regulatory action being taken (such as cautions and imposition of conditions). For 25.6%, the result was no further action. In these matters, further information was received from the practitioner that identified that there was no risk to the public that would warrant regulatory action being taken.
Like most Australian organisations, the sudden restrictions on people movement and social distancing requirements had a significant effect on Ahpra. There are over 300 people in the Registration team alone and it took two weeks to set up all staff to work from home effectively. This was a considerable achievement allowing us to provide seamless customer service, maintain productivity and, where required, introduce necessary process changes.
Ahpra established a short-term pandemic response sub-register to fast track the return to the workforce of experienced and qualified health practitioners. The sub-register enabled doctors, nurses, midwives and pharmacists who had previously held general or specialist registration and left the Register of practitioners or moved to non-practising registration in the past three years to return to practice. Only those who were properly qualified, competent and suitable were returned to the register.
The sub-register was launched on 6 April and will remain in place for up to 12 months. Over 40,000 practitioners who met the criteria were contacted to alert them that they would be added to the sub-register. There was no obligation for anyone added to practise or remain on it. Practitioners can opt out at any time, for any reason.
On 16 April, further health professions were added to prepare for any surge in workforce demand resulting from COVID-19. Around 5,000 physiotherapists, psychologists and diagnostic radiographers were added from 20 April.
A third phase has begun with 180 Aboriginal and Torres Strait Islander Health Practitioners contacted and given the opportunity to opt in (as opposed to opt out). At 30 June, 20 practitioners had registered their interest and were joining the sub-register on 1 July 2020.
Due to the pandemic our state and territory offices were temporarily closed to the public. As a result, it was essential to find a way to help people lodge their applications online, and make sure Ahpra staff working from home could receive and process application forms electronically.
From 27 March, applicants and registered health practitioners were given access to an online upload service that allows them to submit applications and other forms with supporting documents. This significantly reduced hardcopy submissions, enabling practitioners to join the healthcare workforce sooner by reducing the time required to mail and process information. Applicants, registered health practitioners and external stakeholders were advised of the availability of the online upload service via Ahpra and National Board websites, social media posts and emails to major stakeholders.
When we closed the Ahpra offices in each state and territory in late March, we were not sure how many eligible applicants arrived in Australia before our borders were closed. It was important to introduce interim measures quickly to replace the requirement for people to attend in person at an Ahpra office to have their identity verified.
We worked with health service providers to find a solution. To enable people to join the workforce quickly, overseas applicants who hold current in-principle approval of registration are now able to present in person at their intended place of employment in Australia rather than to an Ahpra office to have their identity verified and identity documents certified by a registered health practitioner. That practitioner or other employee at the intended place of employment then submits a copy of the documents to Ahpra via email for final assessment.
Australia closed its borders on 20 March and this development appears to have contributed to a noticeable difference in the number of new registration applications received from overseas-qualified applicants. From 1 April to 30 June, Ahpra received 12.8% fewer applications (852) from overseas applicants with a medical qualification, in comparison to 977 applications in the same period last year.
The border restrictions have also prevented some overseas applicants holding current in-principle approval of registration to present in person at their intended place of employment to have their identity verified. As a result, from 1 April to 30 June, there was a 45.4% reduction in the number of finalised registration approvals (295) of overseas applicants with a medical qualification, in comparison to 540 approvals in the same period last year.
Countering these changes, in the same period we saw a 22.7% increase in the number of requests from international medical graduates (IMGs) with limited or provisional registration, working in Australia, to change their circumstances. A request for a change in circumstances is typically made when the IMG seeks a change to their approved employment and/or supervision arrangements. For the duration of the pandemic, the Medical Board of Australia has streamlined the process to enable IMGs who are working in hospitals to be redeployed more easily without a formal application to the Board. This change was made to ensure that IMGs are quickly available to work in the areas where the Australian health system needs them.
During the 2020 renewal period, nurses and midwives who self-assessed as meeting the following criteria were eligible to submit a financial hardship application:
If financial hardship was determined, the nurse or midwife became eligible to pay the applicable registration fee in two instalments: the first at the time of making the application and the second within three months of the start of the registration period.
Approximately 180 financial hardship applications were received during the renewal period. A similar approach will be offered to other professions for registration renewal.