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Ahpra’s sentiments and perceptions survey shows trust and confidence waning in regulator

The trust and confidence that Australian eyecare professionals have in their regulator have taken a hit, according to a survey of practitioner sentiments and perceptions of the Australian Health Practitioner Regulation Agency (Ahpra) and the National Boards.

The latest results – a snapshot from 2021 – show that while above the average of all health disciplines, the level of trust optometrists had in the Optometry Board of Australia (OBA) were the lowest since the surveys began in 2018. Meanwhile, for medical practitioners including ophthalmologists, trust levels were significantly low in the Medical Board of Australia (MBA), at 38%.

The survey reflected the full spectrum of views towards the OBA, with some feeling it is a trustworthy, open and honest organisation that supports the sector, while others questioned the body’s understanding of the modern-day optometrist and the relevance of the CPD program.

Meanwhile, Australian Society of Ophthalmologists (ASO) president Dr Peter Sumich says trust in the MBA is being undermined by its bureaucratic approach, and the way doctor’s reputations are affected during the complaints process.

Ahpra, the OBA and MBA released these “reputational insights” in late June 2023, which will inform their work to improve engagement with regulated health professions, with the aim of improving trust and confidence in the National Registration and Accreditation Scheme.

The reports provide results from an anonymous survey conducted in late 2021 of a random sample of registered health practitioners. There were 14,670 responses from practitioners across all regulated health professions, including 776 optometrists and 1,059 doctors.

As the survey was voluntary, Ahpra warns the sample from some professions may not be representative of the whole profession. In addition, the survey responses reveal the differing roles of National Boards, Ahpra and professional associations are not well understood, so caution is needed when considering the results.

In total, around 5% of optometrists who responded to the survey have had a complaint about them made to the OBA, and 40% have been audited to check their compliance with mandatory registration standards.

Around 65% of optometry respondents viewed the OBA in a positive light, a decrease compared to 2020 but a higher rate than in earlier years. Optometrists also perceived their board significantly more positively than sentiments toward boards on average (54%).

However, 64% of optometrists indicated that they had trust in the OBA, a 13% decrease from 2020 and the lowest rate of trust recorded in the four years since these surveys began. Confidence also dropped to 66%, which, while 7% lower than the 2020 result, is not inconsistent with previous years’ rates.

“Despite the reductions, these findings were still significantly higher compared to the average trust and confidence reported across all practitioners,” the OBA report found.

Perceptions of trust and confidence in the Optometry Board of Australia since 2018.

When looking across all Ahpra-regulated professions, 52% of practitioners reported trust and confidence in their National Board, representing an 11% decline in trust and a 4% decline in confidence from 2020. As with sentiment toward Ahpra, despite a slight decline, practitioner perceptions of the boards in the latest survey are still more positive than in the 2018 survey, though the decline in trust remains notable.

Practitioners were also asked to rate the level of support they received from Ahpra and the National Boards to maintain or improve their professional practice. When combined, 40% of optometrists rated the support received favourably, 32% rated the support as fair, and 19% rated this negatively. The remaining 10% selected ‘I don’t know’.

“These values are similar to data collected in 2020,” the OBA report stated. “Nevertheless, optometrists remained slightly more likely to rate the support they received positively as compared to the other practitioner groups in the combined sample.”

Medical board findings

Medical practitioners, including ophthalmologists, held much harsher views of Ahpra and the MBA. Almost a quarter of doctor respondents have had a complaint about them made to the regulator, and 8% audited for registration compliance.

Less than half (41%) of respondents viewed the MBA in a positive light. On average, medical practitioners perceived the board significantly less positively compared to practitioner sentiments toward boards overall.

Only 38% of respondents indicated that they had trust in the MBA, a 13% decrease from 2020 values. Confidence in the MBA also declined to 40%.

“Both trust and confidence in the board have declined since the first survey in 2018. Levels of trust and confidence were significantly lower compared to the average across all practitioners,” the MBA report stated.

Sumich, ophthalmologist and president of the ASO, said the Medical Board used to be simple, effective and cheap, with each state having their own board whose job was to register eligible medical practitioners.

“There was an investigatory function and a disputes process. The colleges policed the good and bad on their turf,” he said.

“Then along came Ahpra and the National Law. Depending on your politics, it could be seen as a neat tie up of the many state bodies or a grand socialist plan to nationalise medicine, under the control of bureaucrats and politicians. The Ahpra fees are now 10 times greater than the previous state registration bodies. It has become an organ attempting to justify its own existence and funding and seeking ever greater control over the profession.”

Nowadays, he said investigations of practitioners tended “to occur in backwards fashion to that of natural justice”.

“A vexatious accusation may be made without any proven foundation, and the long delay in investigation and dismissal of the complaint has caused at least half a dozen suicides by emotionally affected medical practitioners. Having your name listed on a website as an impaired, restricted or investigated practitioner is devastating,” he said.

Examples of optometrist quotes and trust in the OBA

 “Their goals of furthering the optometry profession and supporting optometrists nationwide are supported by their actions.”

 “They have been very informative throughout all of COVID and been very supportive.”

 “I feel it is a trustworthy, open and honest organisation.”

 “It ensures all practitioners are well supported throughout their career.”

 “I agree with the standards they have agreed upon and upheld.”

 “They strive to better our profession to increase patient care.”

Examples of optometrist quotes and distrust in the OBA

 “Bureaucratic and self-serving, in it for themselves rather than the profession.”

 “Run by the powers that be rather than the normal everyday practitioner.”

 “They have no idea of how hard it is for allied health professionals to make a living and keep increasing the unpaid work demands by unrealistic CPD and reflective writing requirements that are not helpful. Where is the evidence that this level of requirement improves patient safety?”

 “They do not actively represent the entire profession, I have felt let down by their leadership in the past when support was needed.”

Note: Because the free text questions were not mandatory, some professions had less responses and limited quotes. This was the case for distrust in the OBA, so Ahpra urged caution against making inferences from these comments.

Source: 2021 Practitioner perceptions of Ahpra and the National Boards Supplementary report prepared for the Optometry Board of Australia.

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