Australian Health Practitioner Regulation Agency - Registration

Registration

There are more than 850,000 registered health practitioners in Australia.

Responding to the increasing pressure on Australia’s health workforce was a priority, and we focused on playing our part fully. We set up, maintained and adapted the pandemic sub-registers. National Boards adjusted some requirements to enable applicants to register or renew in the face of COVID-19 restrictions. 

When borders re-opened, it was a priority to register overseas-qualified practitioners to assist governments, employers, healthcare workers and the public.

  • The number of registered health practitioners grew by 3.9% this year to 833,318 (without the inclusion of the practitioners on the pandemic response sub-register). 
  • Including practitioners on the sub-register, the number of registered health practitioners grew by 3.2%, to 852,272
  • 97.4% of all registered practitioners hold some form of practising registration. 
  • 86,558 practitioners hold specialist registration in an approved specialty. 
  • 25,509 practitioners hold endorsement to extend their scope of practice in a particular area because of an additional approved qualification. 
  • At 30 June, there were 20,781 dental practitioners, diagnostic radiographers, medical practitioners, midwives, nurses, occupational therapists, optometrists, pharmacists, physiotherapists, podiatrists, psychologists and Aboriginal and Torres Strait Islander Health Practitioners on the 2021 pandemic response sub-register. 
  • The virtual education sessions we held for employers and stakeholders about the registration processes for international medical graduates led to an improvement in application documentation, timeliness and the customer experience.  

We successfully conducted our third graduate customer experience survey, with 29,184 registrants invited to participate in the voluntary survey and a response rate of 13.2%. Improved experience was evident across many areas, with 83.1% of all survey respondents satisfied overall with how their application was handled by Ahpra. 

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 online form, process and website easy to understand

You can check our Register of practitioners to see if someone is registered and if there are any special requirements on their registration. 

We made the register easier to use. Changes include: 

  • increased prominence of the register on our websites to improve awareness of it 
  • improved search functionality, with predictive text and refined filters (including being able to search by gender and language spoken) 
  • simplified language and pop-up boxes with links to definitions of unfamiliar terms. 
  • 44,098 applications were from new graduates, including nearly 24,340 nursing applications.
    • This is an increase from the previous year of 6.2% new graduate applications and 4.5% nursing applications.
  • We received 32,861 applications for registration between mid-September and March, the peak registration period for new graduates.
    • This is a 4.1% increase from the previous year.
    • On average, the time to decide the outcome of a graduate application reduced to 6 days (from 9 days in 2020/21). We can only finish our assessment after receiving graduate lists from education providers. The time from receipt to finalisation of an application reduced to 47 days (from 52 days in 2020/21).
  • Ahpra received 85,052 applications for registration.
    • This is an increase of 0.5% from last year.
  • 90.8% (77,186 applicants) sought practising registration.
  • Applications for registration as a specialist in the medical profession decreased by 48.2% from 8,931 to 4,628.
    • Fewer applications were received because in 2020/21 we saw an increase in applications of 116.7% over the year before, due to changes to the Health Insurance Act 1973. Those legislation changes resulted in more specialist applications. The number of applications received this year is similar to 2019/20.
  • We finalised 84,141 applications.
    • Of these, 1.9% resulted in conditions being placed or a refusal of registration.
    • There was a 61.2% reduction in the refusals of registration (137 this year compared to 353 last year) with only 43 nurses refused registration compared to 229 nurses last year. This was due to improvements in the assessment of overseas-qualified nurses and midwives.
  • The time to decide the outcome of an application for registration was similar to last year:
    • median time of 2 days (also 2 days in 2020/21)
    • average of 20 days (17 days in 2020/21).
  • After international border restrictions lifted, we had an increase in applications from overseas-qualified practitioners, some of whom had been waiting for years to come into the country. This surge of applicants increased the time taken to finalise applications.

We check every applicant's criminal history before they are registered.

  • 75,543 results received from domestic and international criminal history checks of practitioners and/or applicants 
    • 8.6% increase (compared with 69,571 in 2020/21).
  • 3.8% indicated a disclosable court outcome. Of these, only a few were serious enough to affect a practitioner’s registration: 
    • 15 cases where the check resulted in registration being granted with conditions 
    • 6 cases where the check resulted in refusal to grant registration. 

The number of new registration applications received from overseas-qualified applicants is trending upwards and has shown a bounce back to pre-pandemic figures. 

  • We received 3,536 applications from international medical graduates (IMGs), a 39.7% increase on the 2,531 applications received last year. 
  • We received 2,373 applications from overseas-qualified practitioners across the allied health professions, which is 51.7% higher than the 1,564 applications received last year. 
  • We received 2,015 applications from overseas-qualified nurses and midwives. Internationally qualified nurses and midwives are now required to take an online qualification assessment to identify their pathway to registration. 

Presenting in person 

For registration to be granted, international applicants must present in person to prove their identity. In January 2022, international borders opened and applicants could resume travel to Australia. As part of our public safety measures during the COVID-19 pandemic, applicants were able to present in person at their intended place of employment (or education provider for postgraduate study) to prove their identity, rather than at an Ahpra office. 

Applicants without an intended employer, or those who were unable to present at their intended place of employment due to border travel restrictions, could not complete this requirement. In response, we implemented a new process, which allowed applicants to virtually present in person via an online platform with an Ahpra staff member or with their employer. The virtual present-in-person process can only take place once the applicant is in Australia.

IMG employer virtual education sessions 

During April and May, Ahpra delivered 10 virtual education sessions to employers and stakeholders in every state and a combined session for the territories. These sessions aimed to increase the knowledge and understanding of complex IMG registration processes and saw an improvement in application documentation, timeliness and the customer experience. 

We continue to work with jurisdictions and provide advice on complex registration processes for overseas-qualified practitioners, including IMG pathways to registration and the IQNM qualification assessment process. This supports employers who are targeting recruitment of overseas-qualified practitioners to increase the health workforce and ease pressure on stretched health services.

Internationally qualified nurses and midwives 

IQNMs who wish to apply for registration in Australia are required to complete an online assessment of their qualification/s. Those who hold qualification/s that are substantially equivalent or based on similar competencies to an Australian graduate (and who meet the mandatory registration standards) progress to an application for registration. 

IQNMs who hold relevant but not equivalent qualification/s must successfully complete an outcomes-based assessment before being eligible to apply. These IQNMs complete two exams: 

  • a multiple-choice question (MCQ) examination (knowledge test) 
  • an objective structured clinical examination (OSCE) (behavioural test). 

The MCQ examinations are: 

  • Enrolled nurse – a paper-based exam coordinated by Ahpra and conducted at our offices around Australia. 
  • Registered nurse – the online National Council of State Boards of Nursing (NCSBN) National Council Licensure Examination – Registered Nurse (NCLEX-RN) conducted at Pearson VUE testing centres in more than 20 countries, including Australia; 3,390 candidates sat the exam (including re-sits). 
  • Midwife – an online exam conducted at Aspeq-managed facilities in Australia, New Zealand and internationally; 20 candidates sat the exam. 

This year, 533 internationally qualified registered nurses participated in the registered nurse OSCE. The enrolled nurse OSCE and a midwife OSCE were held throughout the year. 

Conducting all these exams has, to varying extents, been affected by restrictions related to the COVID-19 pandemic and border restrictions. The backlog of IQNs whose assessment was delayed by border closures has since been cleared and we continue to monitor the situation and respond accordingly. 

Pharmacy, psychology, medical radiation practice exams 

Ahpra coordinated the following exams: 

  • 1,691 pharmacy interns were assessed in the oral examination (practice) in October, February and June. All candidates sat the exam online in February due to COVID-19 restrictions. October and June saw a hybrid of online and face-to-face exams. 
  • 66 oral exams were held for pharmacy practitioners holding limited or general registration with conditions on their registration that required the completion of an examination in practice, or in law and ethics. These exams were offered monthly. 
  • 1,217 candidates sat the quarterly national psychology examination. These exams were offered by dual delivery, meaning candidates could choose to sit the exam in a test centre (where available) or by online supervision. 
  • 61 candidates sat the quarterly national medical radiation practice examination. These exams were also offered by dual delivery, in a test centre or online. 

Chinese Medicine Board regulatory exams 

Following the pilot of a multiple-choice exam in 2021, 11 candidates sat the scenario-based multiple-choice exam. It was offered by dual delivery, meaning candidates could choose to sit the exam in a test centre (where available) or by online supervision. Candidates must successfully pass the multiple-choice exam to be eligible to take the objective structured clinical examination (OSCE). The OSCE was not held in 2021/22.

Aboriginal and Torres Strait Islander Peoples are under-represented in our health workforce – this is something we are working with others to change.

Based on the annual workforce survey results: 

  • Aboriginal and/or Torres Strait Islander Peoples' participation in the regulated health professions was 1.2%
  • This is well short of the 3.2% Aboriginal and Torres Strait Islander representation in the general population 
  • 100% of Aboriginal and Torres Strait Islander Health Practitioners are Aboriginal and/or Torres Strait Islander. It is a requirement for registration in that profession. 
  • Paramedicine had the second highest representation with 1.8% of their workforce identifying as Aboriginal and/or Torres Strait Islander. 
  • Midwifery (including dual-registered midwives and nurses) was next with 1.5%, closely followed by nursing (including dual-registered) with 1.4%

Ahpra and the National Boards ask about Aboriginal and/or Torres Strait Islander cultural identity in various application and renewal processes. This enables a more comprehensive understanding of workforce trends and the proportion of the registrant base that identifies as Aboriginal and/or Torres Strait Islander across all health professions. 

In the graduate customer experience survey we asked how we can improve the process for Aboriginal and Torres Strait Islander applicants. 

Survey participants who identified as Aboriginal and/ or Torres Strait Islander graduates (1.8%) suggested: 

  • an Aboriginal and/or Torres Strait Islander Liaison Officer as an alternative contact 
  • more engagement in the registration process with Aboriginal and/or Torres Strait Islander students through their education providers. 

Increasing participation in the registered health workforce is a goal of our Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy. As one of the steps to help achieve this goal, we created seven identified positions in Registration, Research and Evaluation, Statutory Appointments and our Health Strategy Unit.

The COVID-19 pandemic put Australia's health workforce under immense pressure. Following the request of Australia's Health Ministers for more experienced and qualified health practitioners to quickly return to practice, Ahpra and the National Boards established the 2020 pandemic sub-register. 

In April 2021, this sub-register was extended to enable medical practitioners, nurses, midwives, pharmacists and Aboriginal and Torres Strait Islander Health Practitioners to help with the COVID-19 vaccination program. 

In September 2021, the registration of practitioners was changed so they could work in any area supporting the COVID-19 response, not just vaccinations. We took this action in response to a request from states and territories for additional surge health workforce capacity to address the demand for practitioners due to the pandemic. 

Also in September, Ahpra and the National Boards established a new sub-register (the 2021 sub-register), enabling practitioners from 12 regulated health professions to return to practice for up to 12 months, able to work to the full scope of their registration (subject to any notations). 

The 2020 and 2021 sub-registers ran in parallel for a short time, until the 2020 sub-register closed on 5 April 2022. Practitioners on this sub-register either returned to their prior registration status (non-practising registration or unregistered), opted in to extend their temporary registration and be on the 2021 sub-register or applied to transition to the main Register of practitioners.

Each year when they renew, health practitioners are required to make declarations and disclosures.

  • Ahpra renewed registration for 765,078 practitioners.
  • 99.9% of all eligible practitioners renewed online.

We made several changes to the renewals process:

  • For the first time we asked practitioners whether they identify as Aboriginal and/or Torres Strait Islander. We will use this information to help us continue to develop culturally safe ways of working.
  • We continued to review and update renewal information and the renewal questions on the online form to help practitioners better understand what they need to do to renew their registration.
  • Timeframes for decision-making about declarations made by practitioners when renewing improved due to continued review and improvement of the initial risk-assessment model.
  • For the first time, health practitioners who were yet to renew close to the cut-off date were sent text-message reminders in an effort to ensure continuity of registration. This SMS campaign resulted in a marked reduction in the number of practitioners who failed to renew and, therefore, reduced the number of fast-track applications received in the month following the end of the campaign.
  • Boards continued to be flexible with health practitioners who had trouble meeting continuing professional development requirements because of the COVID-19 pandemic.
  • We moved renewals from hard copy to online lodgement. This change helped improve assessment timeframes for practitioners by reducing unnecessary delays due to inaccuracies and time required to mail information. To accommodate practitioners who were unable to access the online platform for renewal, a verbal submission process was implemented. Fewer than 20 health practitioners accessed this service, and successfully finalised their applications for renewal.
  • To help improve timeframes for renewals applications, we removed BPAY as a payment option. Online card payments are faster to process, which speeds up the renewals process.

Students are the health practitioners of the future.

  • 184,353 students were studying to be health practitioners through an approved program of study or clinical training program.

Education providers supply student information so students can be registered.

All National Boards except the Psychology Board register students. Psychology students receive provisional registration.

The student register isn’t public.

A total of 142 government departments, public and private hospitals, healthcare businesses, pharmaceutical companies, medical insurers, and nursing and aged care agencies subscribed to the Practitioner Information Exchange (PIE), a secure web-based system that enables bulk checking of registration status.

We audit practitioners to check that they comply with registration standards – the overwhelming majority do comply.

Ahpra conducts regular audits of health practitioners on behalf of the National Boards. Our auditing provides additional assurance to the public, Boards and practitioners that registration requirements are understood and that practitioners are meeting required Board standards. 

Since we began conducting audits, in 2012, most audited practitioners have been found to comply with registration standards. 

Audit results 

Routine audits resumed this year after being affected by COVID-19 in 2020/21. We completed 8,155 audits.

Audit outcomes:

  • 98.26% compliant 
  • 0.02% compliant (through education) 
  • 0.23% non-compliant 
  • 1.48% no audit action

Some of the 1.48% with no audit action were because: 

  • 0.71% of practitioners changed their registration type to non-practising or failed to renew their registration; usually these were practitioners residing overseas, and those no longer practising but maintaining registration 
  • 0.56% were referred to a co-regulatory jurisdiction to manage, to determine whether any further regulatory action was required. 

How our audit process works 

Registered practitioners are required to comply with a range of national standards. Each time a practitioner applies to renew their registration they must make a declaration that they have met the registration standards for their profession. During an audit, a practitioner is required to provide evidence to support the declarations made in the previous year's renewal of registration. 

The standards that may be audited are: 

  • continuing professional development 
  • recency of practice 
  • professional indemnity insurance arrangements 
  • criminal history. 

All Boards have adopted an educational approach to conducting audits, seeking to balance the protection of the public with the use of appropriate regulatory force to manage those practitioners found to be less than fully compliant. Practitioners who are found to have not quite met the registration standard but who are able to provide evidence of achieving full compliance during the audit period are managed through education to achieve full compliance. 

These practitioners are recorded as being 'compliant (education)' – these cases represented 0.02% of completed audits. 

Compliance with registration standards 

When an audit finds that a practitioner has not met the requirements of the registration standards, all Boards follow an approach that aims to work with the practitioner to ensure compliance before the next renewal period. This may include formally cautioning the practitioner about the importance of complying with registration standards. 

All matters that involve issuing a caution or placing conditions on a registration are subject to a 'show cause' process. This process alerts the practitioner to the intended action and gives them an opportunity to respond before a decision is made. 

Of the practitioners found to be non-compliant in 2021/22, 12 matters were referred to investigation, two resulted in some form of regulatory action being taken (such as cautions and imposition of conditions), and five resulted in no further action. In the ‘no further action’ matters, additional information was received from the practitioner that identified there was no risk to the public.

 
 
 
Page reviewed 22/11/2022