Though Australia’s health workforce is growing, national shortages persist. In December 2023, National Cabinet endorsed the recommendations of the Independent review of Australia’s regulatory settings relating to overseas health practitioners. The review, undertaken by Ms Robyn Kruk AO, is referred to as the Kruk review and aims to make working in Australia simpler, quicker and cheaper for internationally qualified health practitioners, when this can be done safely. 

We welcomed the recommendations of the review and immediately began working on the following reforms to accelerate the integration of internationally qualified practitioners into the Australian health system: 

• The Medical Board of Australia launched a new Expedited Specialist pathway, enabling highly qualified international medical specialists from similar health systems to register more quickly. This year, the pathway opened to eligible general practitioners, anaesthetists, psychiatrists, and obstetricians and gynaecologists. 
• The Nursing and Midwifery Board of Australia introduced a new Registration standard: General registration for internationally qualified registered nurses, offering two additional registration pathways for eligible nurses. These reduce time, complexity and costs related to travel, accommodation and examinations. 
• Health ministers identified additional priority professions: dental, medical radiation practice, occupational therapy, podiatry and psychology. National Boards have begun work on streamlined registration pathways for internationally qualified health practitioners in these and other professions. 
• Ahpra released its new operating system, which delivers a new portal for faster, more secure online applications. Applicants can track their application and communicate directly with their case officer. This new system is key to ensuring that we can continue expanding registration pathways. 

Simplifying English language requirements 

The National Boards (except for the Aboriginal and Torres Strait Islander Health Practice Board) introduced a revised registration standard for English language skills. The standard includes several changes to simplify English language requirements while maintaining public safety. These changes include: 

• expanding the list of recognised English-speaking countries from seven to 30 nations and territories 
• reducing the required writing score for approved English language tests to IELTS 6.5 (or equivalent) and adding the Cambridge English language skills test. 

Reviewing supervised practice 

As part of our response to the Kruk review, Ahpra and relevant National Boards began a rapid review of the Supervised practice framework with an eight-week public consultation that opened on 2 June. The aim is to gather feedback on whether the framework is working and how it could be improved for supervisees, supervisors and employers. 

Retention and attrition 

In February, Ahpra published research in the Australian Health Review based on its Workforce Retention and Attrition Project (WRAP). This project surveyed more than 25,000 health practitioners and examined 10 years of registration data to identify factors influencing retention and attrition across nine health professions: Chinese medicine, chiropractic, dental, medical radiation practice, occupational therapy, optometry, osteopathy, paramedicine and podiatry. 

The results showed that while 79% of respondents plan to maintain their registration, more than 12% were either unsure or intended to leave their profession. Top reasons for leaving included: 

• mental burnout (32.9%) 
• retirement (30.5%) 
• feeling undervalued/unrecognised (28.5%) 
• lack of professional satisfaction (27.9%) 
• work no longer being fulfilling (25.1%). 

Practitioners more likely to consider not renewing their registration or to be unsure of their future included men, practitioners aged over 60 years, those working fewer than 20 hours per week, and non-self-employed practitioners. 

Over a 10-year period (2014–2023): 

• the number of registered practitioners increased by 29.6% 
• the replacement rate – how many new or returning health practitioners enter the workforce for each practitioner that leaves the workforce – had notable fluctuations 
• females consistently exhibited higher replacement rates compared with males 
• exits from the workforce were highest in those aged under 35 pre-2020, and highest in those aged 35–60 post-2020. 

The findings highlight key challenges such as mental burnout, lack of recognition and low job satisfaction. Addressing these issues may significantly improve workforce retention. Ahpra is collaborating with National Boards to deepen understanding of workforce issues and support sustainable solutions across Australia’s health sector.

Using regulatory intelligence to prevent harm

As the healthcare landscape continues to evolve, so too does the way we regulate registered health practitioners. 

To identify risks sooner and protect patient safety and quality in healthcare, our regulatory approach is shifting to be more proactive, data-informed and responsive to emerging models of care. The cornerstone of our regulatory intelligence and harm prevention work is multidisciplinary collaboration and stakeholder engagement. New areas of concern often require a more unified approach across different areas of the health industry. We work closely with other regulators to map new issues that emerge, monitor concerns and develop holistic approaches that result in better outcomes. 

Our Rapid Regulatory Response Unit (RRRU) plays a key role in these proactive efforts. The unit uses regulatory data and intelligence to help it identify practitioners whose conduct may pose a risk to the public, without waiting for notifications to be received. It engages with practitioners, assesses their practice to better understand potential risks to patients, and recommends further regulatory action, if needed, to keep patients safe. 

For example, regulatory intelligence sharing with the Therapeutic Goods Administration (TGA) allowed the RRRU to identify a practitioner who was engaging in high-risk medicinal cannabis prescribing and skirting restrictions imposed by state and territory regulators. As a result, a sufficient threshold was reached for immediate action to be taken to prevent further unsafe prescribing. 
Risks of patient harm have been identified in 69% of practitioners approached by the RRRU. Some practitioners make prompt changes to their practice to address these risks; however, where this is not the case, the relevant National Boards begin formal investigations, take regulatory action or make a referral to another regulator. 

Education and prevention 

Our policy teams lead education and prevention work that helps practitioners understand how their existing obligations apply in new and evolving areas of practice. This clarity supports safe and ethical healthcare and enables Ahpra and the National Boards to respond more nimbly to emerging risks. 

Advances in artificial intelligence (AI) are rapidly evolving and new tools continue to emerge, raising unique practical and ethical issues for their safe use in healthcare. Some AI tools used in healthcare are regulated by the TGA, and we are working closely with them and other agencies on a safe, system-wide approach to AI integration. 

In August, we released guidance to support the safe and ethical use of AI in healthcare, developed in close collaboration with technical experts, other regulators and professional bodies. The guidance reminds practitioners of their obligations around accountability, transparency, informed consent, and legal and ethical considerations. We promoted this guidance widely to practitioners, employers and the public. 

Our proactive regulatory approach also improves awareness of risks that may not be immediately visible, including financial harm to consumers. In May, Ahpra and the Dental and Medical Boards of Australia issued a joint statement on the use of compassionate release of superannuation to fund medical and dental treatments. While early release of superannuation can provide critical access to care for patients who may otherwise be unable to afford care, it also carries a range of financial risks. We are working with the Australian Taxation Office to identify practitioners with high rates of report writing in this area and will take steps to intervene where necessary. 

Investigating advertising complaints 

Advertising can influence a consumer’s decisions regarding their healthcare needs. It is essential that advertising of regulated health services contains information that is accurate, not misleading, and that is supported by acceptable evidence. 

Our advertising compliance team assessed 775 complaints about advertising. Of these: 

• 356 were complaints about corporate entities or unregistered persons, or assessed as serious-risk complaints, and were referred to our Criminal Offences Unit. Of these, 107 were about the advertising of regulated health services, with the remainder about specialist title use or concerns about individuals holding out as registered health practitioners 
• 419 were lower-risk complaints about registered health practitioners. 

Working with practitioners 

The National Law defines how practitioners and others can advertise health services. When we identify that registered health practitioners are non-compliant with the law or other advertising guidelines, we provide them with information about where they have fallen short, along with an opportunity to correct it. We generally only take further regulatory action when this approach is unsuccessful. 

Of the practitioners we contacted because of non-compliant advertising, 74% corrected their advertising early, such that further intervention was not required. We audited 86 practitioners whose advertising remained non-compliant after being given an opportunity to correct it. Of these, 75 subsequently corrected their advertising. National Boards took regulatory action against the remaining practitioners, with: 

• 8 practitioners having conditions imposed on their registration 
• 3 practitioners being cautioned. 

Ahpra may also prosecute advertisers for breaching the National Law. 

Advertising cosmetic procedures 

We assessed 59 complaints about the advertising of cosmetic procedures, which is a point of focus for Ahpra and the National Boards. We also continued our targeted audit of advertising about cosmetic surgery and assessed advertising for 93 practitioners and health services.

Doctor banned over botched facelift procedure 

In June, a Queensland tribunal cancelled a doctor’s registration after a patient left his clinic in an ambulance with uncontrolled bleeding that required surgery to repair. The doctor performed a cosmetic procedure that was beyond his level of skill and experience in an unlicensed clinic. He did not inform the patient of his lack of training or experience, and the clinic website gave misleading information about his credentials. 

This decision marks the first tribunal outcome from a case reported to the Cosmetic Surgery Enforcement Unit (CSEU).

Making cosmetic surgery and procedures safer

Ahpra and the National Boards are committed to making both surgical and non-surgical cosmetic procedures safer. In June, we published advance copies of the Guidelines for registered health practitioners who perform non-surgical cosmetic procedures and the Guidelines for advertising higher risk non-surgical cosmetic procedures ahead of their implementation in September 2025. These guidelines will make it simpler for consumers to make safe and informed decisions and will strengthen safeguards across the cosmetic industry when they come into effect. They also set out our expectations for practitioners already practising in this area. And they outline that further training or education will be necessary for many practitioners who want to expand their scope of practice into this field. Because of these changes, Australians considering cosmetic procedures such as anti-wrinkle injections and fillers will have greater protections and their welfare put first. 

Cosmetic Surgery Enforcement Unit 

Since its establishment in 2022, the CSEU has handled all cosmetic surgery complaints received by Ahpra. Until March 2025, it also had a hotline where members of the public and practitioners could make confidential or anonymous notifications. Since March, all calls have been directed to our general notifications hotline. In total, we received 485 calls related to cosmetic surgery this year. 

Complaints from all sources about cosmetic surgery continued to be high, while many of our remaining investigations entered their final and most complex stages. A total of 159 notifications about cosmetic surgery were received in the past year. The CSEU finalised 131 investigations, including referring seven practitioners to tribunal and taking other regulatory action against 16 practitioners. 

As of 30 June, the CSEU was managing 206 notifications involving 54 practitioners. Of these, 140 notifications (72%) relate to just seven practitioners, all of whom are either not practising or have registration restrictions due to serious performance and conduct concerns. 

Refining our approach 

To manage the increased workload, the CSEU shifted its approach to focus on finalising the most serious cases. New cosmetic surgery–related notifications are now handled by Ahpra’s broader Notifications team, supported by the CSEU’s expertise and processes. This new approach delivers greater regulatory capacity in this growing area of practice, while allowing the CSEU to finalise its critical investigations more efficiently.

Expert advisory group for minimising practitioner distress

Around the globe, there is growing awareness about the need to make regulatory processes more compassionate. Through our interviews and surveys with practitioners and notifiers, we know that people can find going through a regulatory process stressful, and practitioners often feel shame and stigma about receiving a complaint. We have committed to improving our processes to minimise distress by implementing the 15 recommendations and 33 actions of an Expert Advisory Group (EAG) in 2023. We have now completed one-third of the actions. 

Many of the achievements so far have been changes to how we manage concerns about a practitioner’s health, as practitioners with pre-existing mental health and substance use disorders can be among the most vulnerable to distress. We have reduced the use of immediate action in impairment cases; increased the use of assessments from a practitioner’s own treating practitioner in preference to those from an independent practitioner; and worked on improving staff and Board member understanding of distress and vulnerability and their awareness of the risk of suicide and self-harm. Making our processes more compassionate for practitioners, and reducing their distress, also means that they are more likely to constructively engage with regulation and, ultimately, provide safe healthcare for patients. 

Before an action can be considered closed, Ahpra’s senior leaders must be assured that the change is embedded into our daily operations and supported to remain firmly in place. This is because the EAG project is part of our long-term commitment to becoming a more human-centred regulator. It is considered, thoughtful work that benefits greatly from collaboration and input from partners across Australia and internationally.

Forum for shaping better regulatory experiences 

In April, we hosted a forum on ‘Shaping better regulatory experiences’. This brought together more than 140 people from across the health system, including employers, professional associations, practitioner support services, indemnity providers, educators, co-regulators, National Boards and Ahpra staff. 

The forum focused on improving the experience of practitioners going through a regulatory process, with a strong emphasis on compassion, collaboration and practical change. It provided a valuable opportunity to share insights, strengthen partnerships and explore new ways to support practitioners. 

Lived experience stories were central to the day, offering powerful reflections on the emotional toll of regulatory processes. These stories highlighted the impact of stress and isolation, and the importance of timely, meaningful support. Many attendees shared that these accounts left a lasting impression and deepened their commitment to making changes. 

Presentations from Ahpra and the Black Dog Institute, along with panel discussions featuring a range of partners, showcased reforms already underway. These included improved approaches to communication and education around regulatory processes, greater use of peer and workplace supports, and initiatives to expand support services for more professions. Building on these insights, breakout sessions invited attendees to share ideas about how to reduce shame and stigma, improve cultural safety and increase the uptake of support services. 

The forum reinforced our shared responsibility to minimise regulatory distress and change the culture of healthcare to increase compassion and support for health practitioners. It built on the work of the EAG, whose recommendations continue to guide our efforts to become a more humane regulator.

We continued implementing the Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020–2025, now in its fifth year, and again made significant progress across all priority areas. 

Eliminating racism from healthcare 

We launched Australia’s first Aboriginal and Torres Strait Islander Anti-Racism Policy on National Close the Gap Day, during the same week as the International Day for the Elimination of Racial Discrimination. Wakaya man Distinguished Professor Yin Paradies, a leading scholar in racism and cultural safety, led the development, which centres Aboriginal and Torres Strait Islander voices from our staff, Board and committee members. 

The policy strengthens accountability and sets clear expectations for culturally safe, anti-racist practice across healthcare regulation. 

Culturally safe notifications in focus 

Aboriginal and Torres Strait Islander practitioner and community members continue making regulatory decisions through the medical and nursing and midwifery Indigenous National Special Issues Committees. 

Our ongoing work to create a culturally safe notifications process was featured by the National Indigenous Health Leadership Alliance in this year’s Close the Gap report. 

Building partnerships for impact 

We showcased our anti-racism and cultural safety work at conferences, drawing on collective strengths with inspiring Indigenous co-presenters on topics including: 

• the development of our Aboriginal and Torres Strait Islander Anti-Racism Policy with Professor Yin Paradies 
• health practitioner workforce insights with the Aboriginal and Torres Strait Islander Health Practice Board of Australia (ATSIHPBA) and the National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners (NAATSIHWP)
• embedding a culturally safe notifications process with Yardhura Walani of the Australian National University 
• Cultural Safety Accreditation and Continuing Professional Development Upskilling Framework and Strategy co-design with Weenthunga Health Network. 

Celebrating excellence 

Ahpra’s Mob Meet Up brought together Aboriginal and Torres Strait Islander staff, and Board and committee members, alongside National Indigenous Health Leadership Alliance representatives. The national gathering celebrated black excellence and Indigenous ways of knowing, being and doing.

Indigenous leadership in action 

The National Scheme Combined Meeting in May featured an impressive line-up of Indigenous keynote and guest speakers including: 

• Jamaican and Guyanese UK-based anti-racism expert Dr Shereen Daniels 
• Bardi, Jabirr Jabirr woman Ms Iris Raye, ATSIHPBA Chair 
• Kuku Yalanji man Karl Briscoe, CEO of NAATSIHWP and co-Chair of the Aboriginal and Torres Strait Islander Health Strategy Group (Strategy Group) 
• Professor Yin Paradies 
• Gumulgal woman Associate Professor Lisa Whop, Yardhura Walani epidemiologist and Strategy Group member 
• Waywurru woman Sam Paxton, CEO of Weenthunga Health Network. 

International recognition 

The Council on Licensure, Enforcement and Regulation (CLEAR) selected Ahpra’s Aboriginal and Torres Strait Islander Health Strategy Unit (HSU) to deliver the keynote speech at their Annual Education Conference in Baltimore in the USA, where they spoke on the topic of ‘Anti-racism approaches in regulatory decision making: moving beyond the performative’. The HSU also presented on the topic of ‘Regulating in the colonies: Australia, New Zealand and British Columbia’ with First Nations partners. 

Gamilaraay woman Jayde Fuller, National Director of the HSU, now co-chairs CLEAR’s Diversity, Equity and Inclusion committee, expanding our international influence. 

Growing representation 

Aboriginal and Torres Strait Islander workforce participation in the National Scheme and within Ahpra continues to expand. The total number of Aboriginal and/or Torres Strait Islander Ahpra staff is up to 30, seven more than last year. 

Targeted recruitment led to the appointment of nine new Aboriginal and Torres Strait Islander Board and committee members, increasing the current total to 45.