# Health Impairment Notifications About Doctors to the Australian Medical Regulator, 2012–2022: A Retrospective Cohort Study

## TL;DR

This study examines health impairment reports for Australian doctors from 2012 to 2022, finding that male, older, and rural doctors are more likely to be reported, with serious consequences like practice restrictions.

## Contribution

The study identifies demographic and professional factors influencing health impairment notifications and provides evidence for targeted interventions to support doctors and protect patients.

## Key findings

- Health impairment notifications were recorded for 1.1% of registered Australian doctors between 2012 and 2022.
- Male doctors, older doctors (70+), and those in rural/remote areas had higher notification rates.
- Anaesthetists and psychiatrists had notably higher rates of specific types of impairments, like substance use.

## Abstract

To assess the prevalence, characteristics and outcomes of health impairment notifications to the Australian Health Practitioner Regulation Agency (Ahpra) and to assess the influence of doctor age, sex, specialty, practice location and country of training on the incidence of health impairment notifications.

Retrospective cohort study; analysis of linked de‐identified Ahpra medical register and health impairment notifications data.

All doctors registered to practise in Australia (except New South Wales) for whom notifications of concerns about physical or mental illness, cognitive decline, substance use disorder or other impairment to safely practising medicine were received by Ahpra during 1 July 2012–30 June 2022.

Health impairment notifications, overall and by notification type and specialty; influence of doctors' characteristics on the incidence of notifications.

During 2012–2022, 112,677 doctors were registered to practise in Australia (other than New South Wales). A total of 1732 health impairment notifications were recorded, including at least one notification for 1258 doctors (1.1%). In multivariable analyses, the incidence of health impairment notifications was higher for male than female doctors (adjusted incidence rate ratio [aIRR], 1.45; 95% confidence interval [CI], 1.26–1.67), for doctors aged 70 years or older than for those aged 30–39 years (aIRR, 2.92; 95% CI, 2.30–3.70) and for doctors in regional (aIRR, 1.33; 95% CI, 1.12–1.58), rural (aIRR, 1.27; 95% CI, 1.03–1.57) and remote areas (aIRR, 1.55; 95% CI, 1.03–2.33) than in metropolitan areas. Among doctors with specialist qualifications, the incidence of notifications was higher for psychiatrists than internal medicine physicians (aIRR, 2.28; 95% CI, 1.62–3.21) and the incidence of substance use notifications was highest for anaesthetists (vs. internal medicine physicians: aIRR, 2.83; 95% CI, 1.66–4.83). Compared with doctors who trained in Australia, doctors who trained in non‐comparable jurisdictions were less likely to be subjects of health impairment notifications (aIRR, 0.53; 95% CI, 0.43–0.64). Of 1708 notifications with final Ahpra determinations, 367 (21.5%) resulted in practice restrictions or removal from practice.

Health impairment notifications are infrequent but can have serious consequences for doctors. The incidence of health impairment notifications is influenced by doctor age, sex, specialty and location. Specific measures that take these factors into account could support workplace health and safety for doctors and protect patients from harm.

The known: Fear of regulatory involvement may deter unwell doctors from seeking help, but health care regulators must protect the public by ensuring that doctors are fit to practise.

The new: During 2012–2022, the medical regulator received notifications of concern about health impairments for 1% of doctors in Australia. Reports were more frequent for male doctors, doctors aged 70 years or older, psychiatrists and general practitioners. Disproportionate numbers of anaesthetists and rural doctors were subjects of substance use notifications. The medical regulator imposed practice restrictions, such as conditions or suspension, following 21.5% of notifications.

The implications: Responses to reports of impairment in doctors should be targeted and evidence‐based, providing support for doctors while protecting patients.