Australian Health Practitioner Regulation Agency - Registration
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Annual report 2022/23

Responding to the increasing pressure on Australia’s health workforce was a priority across much of our work.

We strengthened our engagement with employers to ensure registration requirements are clearly understood, improved timeframes to assess applications for registration, and created a new information hub for international applicants on our website.

The new hub and other changes are helping international applicants find information about getting registered in Australia quickly and easily.

These initiatives were well aligned to the findings from the interim report of the Independent review of overseas health practitioner regulatory settings (referred to as the Kruk review), which was released in April.

The year in summary

  • The number of registered health practitioners grew by 2.9% this year to 877,119.
  • 96.6% of all registered practitioners hold some form of practising registration.
  • 88,318 practitioners hold specialist registration in an approved specialty.
  • 27,156 practitioners hold endorsement to extend their scope of practice in a particular area because of an additional approved qualification.
  • The temporary pandemic sub-register was closed on 8 June 2023 and any practitioners who remained on it were transitioned to ongoing registration.

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

We have continued to improve the register to make it more accessible and easy to use. Changes include:

  • increased prominence of the register on our redesigned website, with the ‘Look up a practitioner’ button visible on every page
  • 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.

A total of 161 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). The PIE is a secure web-based system that enables bulk checking of registration status, drawing on public information published on the Register of practitioners. This is an increase from 142 subscribers in 2021/22.

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

  • 79,759 results were received from domestic and international criminal history checks of practitioners and/or applicants.
  • This is an increase on the 75,543 results received in 2021/22.

The temporary pandemic response sub-register was established in April 2020 to enable a rapid return to the workforce of experienced and qualified health practitioners to assist in the COVID-19 pandemic.

These practitioners were selected because they had previously held general or specialist registration and had become unregistered or moved to non-practising registration in the previous three years.

Since then, there have been various adjustments to the sub-register to optimise Australia’s health workforce capacity. At its peak, there were more than 40,000 practitioners on the sub-register and around 1,000 have successfully applied to return to the main Register of practitioners.

The National Boards decided to close the sub-register in June 2023, and return the last 1,700 practitioners to the main register. These practitioners will be able to apply to renew their registration at the next scheduled renewal date for their profession.

After this transfer of the remaining practitioners, the sub-register was closed.

We finalised 96,136 applications for registration, an increase of 14.3% from last year.

We received 96,879 applications for registration. The largest number were from new graduates, followed by practitioners transitioning from provisional to general registration, and practitioners transitioning from general to non-practising registration.

  • 91.4% (88,534 applicants) sought practising registration.
  • 1.7% resulted in conditions being placed or a refusal of registration.
  • There was a slight reduction in the refusals of registration (111 this year compared to 137 last year).
  • 3,805 applicants withdrew before a final decision was made on their application.

New graduate applications

We received 42,565 applications from new graduates, including 24,084 nursing applications.

  • This is a 3.5% decrease in new graduate applications from last year.
  • 31,668 of these applications were received between mid-September and March, the peak registration period for new graduates. This is a 3.6% decrease from last year.
  • Timeframes to assign, assess, make first contact and finalise when complete all improved on last year and contributed to our improved graduate survey results. The average time to assign and assess an application was down from 11 days to seven.

End-of-year graduate survey

The end-of-year graduate survey is a voluntary customer experience survey now in its fourth year. The results give us valuable insights about the graduate experience of joining the National Scheme as a qualified health practitioner.

This year we invited 29,059 new graduates to participate in the survey and 2,817 responded (a 9.7% participation rate). Overall, most measures improved when compared to last year.

This year saw the best result to date in how well we managed graduate applications, with 86.2% of respondents satisfied overall, compared to 83.1% last year.

International applicants

This year, 19,288 overseas-qualified practitioners gained registration, a 92.5% increase from last year.

  • We registered 4,211 international medical graduates (IMGs), a 41.1% increase on last year.
  • We registered 273 internationally qualified midwives and 11,188 internationally qualified nurses, an increase of 127.5% and 148.1%, respectively.
  • We registered 3,616 overseas-qualified practitioners across the allied health professions, an increase of 50.3% from last year.

Mutual recognition for New Zealand practitioners

The Trans-Tasman Mutual Recognition Act 1997 (TTMR Act) allows for many types of health practitioners registered in either Australia or New Zealand to apply for registration in the other country through a streamlined registration process. The objective is to remove regulatory barriers and drive workforce mobility for health practitioners who hold current practising registration in either jurisdiction.

Registration in Australia will only be granted in the same category as the practitioner’s New Zealand registration. Any conditions, limitations or endorsements that apply in New Zealand may also apply to the practitioner’s registration in Australia. For most TTMR matters, a final registration decision must be made within 30 days of receipt of the application.

There has been a significant increase in TTMR applications in the past 12 months. Ahpra approved 3,562 TTMR applications in 2021/22 and 9,129 in 2022/23. The increase is most notable for nurses, occupational therapists, medical radiation practitioners and physiotherapists.

The Kruk review

In September, National Cabinet commissioned the Independent review of overseas health practitioner regulatory settings to examine the entry of overseas-trained health professionals who want to work in Australia. The review considered ways to help ease health workforce shortages while maintaining high standards in healthcare quality and patient safety.

Ms Robyn Kruk AO was appointed to lead the review, which focused on five reform priorities:

  • improve the experience of applicants seeking to come to Australia to work as registered health professionals
  • expand ‘fast track’ registration pathways for those health professionals with comparable qualifications and skills to Australian requirements
  • improve workforce planning for the Australian health system
  • increase flexibility in regulation while supporting safety
  • enhance regulator performance and stewardship.

In April, Ms Kruk released an interim report containing 56 recommendations across these five reform priorities. Ahpra and the National Boards have a significant program of work to improve the recognition of qualifications and assessment of skills for overseas-qualified practitioners, including:

  • developing our Business Transformation Program, which will create a better experience for applicants seeking registration in Australia
  • increasing our staffing to improve the timeframe for assessment of applications
  • working towards new fast-track pathways for comparable practitioners in priority professions
  • significantly boosting examination capacity for internationally qualified nurses and midwives who need structured assessment of their knowledge and skills for registration.

Ms Kruk is expected to hand down her final report in late 2023.

Comprehensive guide for international practitioners

Ahpra launched a new webpage to provide clear information to international applicants. A flyer was also developed which outlines what international practitioners must do before they can start practising in Australia. This includes advice on:

  • visa applications
  • certificates (good standing or registration status)
  • assessment of qualifications
  • applying for registration as a health practitioner
  • how to get a provider or prescriber number.

Accelerated assessments

We implemented a new approach to assessing applications, which involves an initial risk assessment and more senior staff assessing applications at their earliest stage to reduce delays. This immediately improved the time it takes to make first contact with an applicant and reduced the average timeframe to assess applications from 29 days to 10 days.

Supporting employers

We continue to work with jurisdictions and provide advice on improving the complex registration processes for overseas-qualified practitioners, including IMG pathways to registration and the internationally qualified nurse and midwife (IQNM) qualification assessment process. This supports employers who are seeking overseas-qualified practitioners to ease pressure on stretched local health services.

Ahpra delivered five virtual education sessions to employers and stakeholders who work with international applicants in every state and territory. The objective of the sessions was to increase understanding of complex IMG and IQNM registration processes. These sessions received very positive feedback from employers and resulted in more complete and accurate applications being submitted. This in turn reduced the time taken to finalise applications and improved the overall experience for applicants and employers.

Some applicants sit an exam

Internationally qualified nurses and midwives 

IQNMs who wish to apply for registration in Australia are required to complete an online assessment of their qualifications. Those who hold qualifications 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 qualifications 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. Two exams (including re-sits) were conducted this year.
  • 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. This year, 8,077 exams (including re-sits) were conducted, a large increase from 3,390 last year.
  • Midwife – an online exam conducted at Aspeq-managed facilities in Australia, New Zealand and internationally. There were 31 exams (including re-sits) this year.

This year, 1,489 internationally qualified registered nurses participated in the registered nurse OSCE. The midwife OSCE was held three times throughout the year.

Pharmacy, psychology, medical radiation practice and Chinese medicine exams

Ahpra coordinated the following exams:

  • 1,945 pharmacy interns were assessed in the oral examination (practice) in October, February and June. All these exams used a hybrid online and face-to-face model.
  • 89 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.
  • 1,569 candidates sat the quarterly national psychology examination. Candidates could choose to sit the exam in a test centre (where available) or by online supervision.
  • 83 candidates sat the quarterly national medical radiation practice examination. These exams were also offered in a test centre or online.
  • 26 candidates sat the scenario-based multiple-choice exam for Chinese medicine. Again, candidates could choose to sit the exam in a test centre (where available) or by online supervision. The OSCE for Chinese medicine was not held in 2022/23.

Ahpra renewed registration for 800,943 health practitioners. This is an increase of 4.7% from last year.

Each year when they renew, practitioners must confirm they continue to meet their National Board’s mandatory registration standards. They must also let us know if there’s been any change to their criminal history or any health impairment that may negatively affect their ability to safely practise. This year we revised communications to practitioners about what they need to tell us at renewal, which reduced the number of unnecessary disclosures.

This year, health practitioners across all professions were expected to fully meet their continuing professional development requirements – some expectations had been reduced or paused during the first years of the COVID-19 pandemic. Practitioners who hadn’t met the requirements had to let us know.

We continued to transition all renewals to online, phasing out hard-copy forms. To accommodate practitioners who were unable to access the online platform for renewal, a verbal submission process was implemented. Only 11 health practitioners accessed this service, and all successfully finalised their application for renewal.

From time to time, we are challenged to respond quickly and decisively to ensure positive health outcomes.

Critical timing for specialist plastic surgery

We registered a specialist plastic surgeon under urgent circumstances this year, which resulted in positive health outcomes for his patients. A children’s hospital called to advise that a specialist surgeon needed to be registered so he could treat 30 children who required his expertise. Eight of the children needed operations for craniofacial deformities that had to be precisely timed with their developmental requirements, so registering the surgeon in a timely manner was crucial.

Our team worked out of hours to ensure the right information reached the Medical Board of Australia delegate committee at short notice, liaised within Ahpra to ensure the importance of the situation was understood and the case given priority, and ensured the Register of practitioners was updated without delay.

The team’s quick work meant the specialist plastic surgeon was registered in time to start reviewing cases and operating within a week, in time for the first scheduled surgery. 

Our part in Australia’s first-ever uterine transplant operation

In late 2022 our international registration team was delighted to play a part in enabling Australia’s first-ever uterine transplant operation.

The surgery was part of a research trial at the Royal Hospital for Women in Sydney.

After receiving several limited registration applications for the specialists from Sweden on 13 December, our team worked throughout the Christmas period to prepare papers and liaise with the MBA delegate committee, to finalise registration in time for the operation on 10 January.

The life-changing surgery was a success, and a thank you letter from hospital staff confirmed it could not have happened without the efforts of our dedicated regulatory officers.

It was an outstanding achievement for all involved and our team was proud to help this landmark surgery occur in Australia.

Aboriginal and Torres Strait Islander Peoples are under-represented in our health workforce. Increasing participation in the registered health workforce is a goal of our Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy.

Ahpra and the National Boards ask about Aboriginal and/or Torres Strait Islander cultural identity in application and renewal processes. This enables us to understand workforce trends and the proportion of registered health practitioners who identify as Aboriginal and/or Torres Strait Islander.

At 30 June:

  • Aboriginal and/or Torres Strait Islander Peoples’ participation in the regulated health professions was 1.2%.
  • This is well short of the 3.8% 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.
  • Midwifery (including dual-registered midwives and nurses) had the second-highest representation with 2.3% of their workforce identifying as Aboriginal and/or Torres Strait Islander.
  • Paramedicine was next with 2.0%, followed by nursing (including dual-registered) with 1.5%.
  • During the end-of-year new-graduate registration campaign, an additional 527 health practitioners who identified as Aboriginal and/or Torres Strait Islander joined the National Scheme (across all professions).

Engagement and support

A new Aboriginal and Torres Strait Islander Engagement and Support team was established in July to better support Aboriginal and Torres Strait Islander applicants, registrants and stakeholders to engage with Ahpra’s registration processes.

Supporting Aboriginal and Torres Strait Islander health practitioners (across all professions) to join the health workforce and helping them have a positive and culturally safe experience is the Engagement and Support team’s core purpose.

The team initially focused on supporting Aboriginal and/or Torres Strait Islander graduates with their registration applications (especially with any issues that arose or disclosures they needed to make), before expanding the support service to the nursing and midwifery renewal campaign. The team will continue to use feedback obtained from the new graduate survey, relevant stakeholders, and directly from the applicants and registrants they support, to improve the services provided by Ahpra to Aboriginal and/or Torres Strait Islander applicants and registrants.

Students are the health practitioners of the future.

  • 183,900 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 is not open to the public.

We audit practitioners to check that they comply with registration standards. Our approach to audits is designed to be educative and ensure that practitioners understand and meet the requirements of their profession’s registration standards.

Auditing provides additional assurance to the public, Boards and practitioners that practitioners are meeting required standards.

Since we began conducting audits, in 2012, the overwhelming majority of audited practitioners have been found to comply with registration standards.

In 2022/23, we did not complete as many audits as in previous years because we transferred resources to focus on assessing more applications for registration.

Audit results

We completed 2,956 audits with a compliance rate of 95.8%.

Audit outcomes:

  • 95.8% compliant
  • 0.1% compliant through education
  • 1.4% non-compliant
  • 2.7% no audit action

Of the 81 (2.7%) matters with no audit action:

  • 62 practitioners changed their registration type to non-practising or failed to renew their registration; usually these were practitioners residing overseas or those who were no longer practising but maintained registration
  • 19 practitioners were referred to a co-regulatory jurisdiction to manage, to determine whether any further regulatory action was required.

Of the 40 (1.4%) practitioners found to be non-compliant:

  • 10 matters resulted in no further regulatory action, after additional information was received that indicated there was no risk to the public
  • 5 practitioners were cautioned
  • 25 practitioners were referred for further investigation.

A further 928 audits were initiated but not completed. Due to the timing of these audits, we expect to complete these matters in parallel with the practitioners’ next renewal application.

How our audit process works

Audits ensure that a practitioner’s disclosures at renewal are accurate. 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.

When an audit finds that a practitioner has not complied with standards audited, Boards identify the risks that need to be considered. 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 through education’.

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.

Page reviewed 9/11/2023