title: Outcomes of notifications to health practitioner boards: a retrospective cohort study.
abstract: Medical boards and other practitioner boards aim to protect the public from unsafe practice. Previous research has examined disciplinary actions against doctors, but other professions (e.g., nurses and midwives, dentists, psychologists, pharmacists) remain understudied. We sought to describe the outcomes of notifications of concern regarding the health, performance, and conduct of health practitioners from ten professions in Australia and to identify factors associated with the imposition of restrictive actions.
  
  
  
  We conducted a retrospective cohort study of all notifications lodged with the Australian Health Practitioner Regulation Agency over 24 months. Notifications were followed for 30-54 months. Our main outcome was restrictive actions, defined as decisions that imposed undertakings, conditions, or suspension or cancellation of registration.
  
  
  
  There were 8307 notifications. The notification rate was highest among doctors (IR = 29.0 per 1000 practitioner years) and dentists (IR = 41.4) and lowest among nurses and midwives (IR = 4.1). One in ten notifications resulted in restrictive action; fewer than one in 300 notifications resulted in suspension or cancellation of registration. Compared with notifications about clinical care, the odds of restrictive action were higher for notifications relating to health impairments (drug misuse, OR = 7.0; alcohol misuse, OR = 4.6; mental illness, OR = 4.1, physical or cognitive illness, OR = 3.7), unlawful prescribing or use of medications (OR = 2.1) and violation of sexual boundaries (OR = 1.7). The odds were higher where the report was made by another health practitioner (OR = 2.9) or employer (OR = 6.9) rather than a patient or relative. Nurses and midwives (OR = 1.8), psychologists (OR = 4.5), dentists (OR = 4.7), and other health practitioners (OR = 5.3) all had greater odds of being subject to restrictive actions than doctors.
  
  
  
  Restrictive actions are the strongest measures health practitioner boards can take to protect the public from harm and these actions can have profound effects on the livelihood, reputations and well-being of practitioners. In Australia, restrictive actions are rarely imposed and there is variation in their use depending on the source of the notification, the type of issue involved, and the profession of the practitioner.
authors.affiliation: Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, 3010, Australia. m.spittal@unimelb.edu.au.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Spittal
authors.affiliation: Stanford University School of Medicine and Stanford Law School, 117 Encina Commons, Stanford, CA, 94305, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Studdert
authors.affiliation: Auckland Law School, The University of Auckland, Private Bay 92019, Auckland, 1142, New Zealand.|Melbourne Law School, The University of Melbourne, Parkville, Victoria, 3010, Australia.
authors.forename: Ron
authors.initials: R
authors.lastname: Paterson
authors.affiliation: Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, 3010, Australia.
authors.forename: Marie M
authors.initials: MM
authors.lastname: Bismark
mesh_terms: D001315:Australia; D015331:Cohort Studies; D004647:Employee Discipline / Q000379:methods / Q000706:statistics & numerical data*; D006075:Governing Board; D006282:Health Personnel; D006801:Humans; D008297:Male; D012189:Retrospective Studies
keywords: Dentists; Disciplinary action; Doctors; Nurses; Pharmacists; Psychologists