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Demystifying Regulation: An Overview for Audiologists (Audiology Australia)

May 8, 2024

By Eleanor Hoskins, Policy and Advocacy Manager, Audiology Australia

 

Background

The debate over the regulation of audiologists in Australia is complex. Striking a balance between regulation and flexibility is essential to support patient safety, high professional standards, and the advancement of the audiology sector. Ultimately, the goal should be to have a regulatory environment that optimises the delivery of high-quality audiological services while promoting innovation and accessibility for all Australians. Some may see audiology as an ‘unregulated’ profession, but in fact the audiology sector is regulated through a number of key standards facilitated by Audiology Australia (AudA) and the National Alliance for Self Regulating Health Professions (NASRHP). In addition, audiologists must adhere to the standards set in the National Code of Conduct for Health Care Workers. Through these mechanisms, AudA ensures compliance with professional standards, certification, accreditation and public safety.

Numerous attempts have been made to advocate for the audiology profession to join the National Regulation and Accreditation Scheme (NRAS). Each time the government provided clear responses that the profession does not meet criteria to join the NRAS, which would allow audiologists to be registered with the Australian Health Practitioner Regulation Agency (Ahpra). The regulation environment currently in place for AudA and a number of other self-regulating professions is defined by NASRHP and as a member we meet all the relevant standards. This means we are regulated to almost the identical standard as the professions regulated through the NRAS.

We know our members want to be seen and recognised within the sector and more widely among the other health practitioners. Our most recent survey asked members the most important advocacy issue they wanted AudA to address. A quarter of members said they wanted increased representation and an uplifting of professional standards, 16% called for stricter regulation environment, whilst 7% specified Ahpra registration as a dedicated regulation function. We also need to consider the sector as a whole and what that will mean practically for audiologists, consumers and businesses in each of the regulation environments. Scope of practice and roles within the sector may change with registration but the common goal should be a collaborative and effective approach to hearing health.

 

NASRHP: What’s in it for me?

To practice audiology and receive government funding through Medicare, HSP and NDIS an audiologist is required to be an accredited member of a professional practitioner body (PPB), either Audiology Australia or the Australian College of Audiology Incorporating HAASA.  AudA is the only professional body which is an approved member of the National Alliance of Self-Regulating Health Professions (NASRHP), the peak body representing self-regulating health professions in Australia. To obtain membership, the health profession must meet the minimum educational standard of the Australian Qualification Framework (AQF) Level 7 (Bachelor’s degree) from an Accredited University and the benchmark standards for regulation and accreditation. The NASRHP standards including the Code of Conduct and Complaints procedures are closely modelled on NRAS standards. AudA has met and continues to meet these rigorous standards required for membership of the NASRHP.

The standards include:

  • Scope of Practice
  • Practitioner Certification Requirements
  • Code of Conduct
  • Professional Indemnity Insurance
  • Complaints Procedure
  • Mandatory Declarations
  • Competency Standards
  • English Language Requirements
  • Course Accreditation
  • Recency and Resumption of Practice
  • Continuing Professional Development

In January this year, AudA renewed its membership. All 11 standards were met with minor amendments made to 5 areas, mainly with regards to updating publicly facing documents containing relevant information, to ensure full compliance.

 

Accreditation: does it matter?

Accreditation assures the general public that the audiology degree programs in Australia have the appropriate qualities to produce professional audiologists, with the knowledge, skills and attributes required to practise audiology safely and competently in Australia. The rigorous course accreditation process is defined by NASRHP and administered by Audiology Australia.

When an individual is awarded a Masters of Audiology degree, they can be assured they have been trained as an allied health professional to meet the highest standards set by NASRHP and aligned to Ahpra. Armed with this post graduate degree, and a period of internship they are eligible for membership of Audiology Australia and can be confident their training equips them to practice audiology according to the National Competency Standards set by NASRHP and defined by Audiology Australia. As the member progresses through their career, they participate in our Continuing Professional Development program which is run according to NASRHP guidelines to ensure all members maintain the high standards set by this agency. The continued participation in CPD activities is designed to ensure all audiologists continue to develop clinical competence and confidence and grow professionally. Completing the CPD program annually entitles them to use the postnominal  Audiology Australia Accredited audiologist (AAudA).

 

The AudA Code of Conduct

The National Code of Conduct for Health Care Workers sets minimum standards of conduct and practice for all health care workers, both those that work under the NRAS and those working in other regulatory or self- regulated environments, including audiologists and audiometrists. The Federal Government recognised the need to align ‘unregistered’ health care workers to the same code of conduct required under the NRAS and this change was agreed and legislated in 2015. Each state and territory is responsible for implementing its own arrangement with respect to the National Code, and seven of eight state and territories have now adopted the Code

As an additional layer of support and compliance AudA designed a Code of Conduct specific for audiologists that is consistent with, and based upon, the National Code of Conduct for Health Care Workers. Our Code of Conduct aligns with NASRHP (and Ahpra) requirements.

 

Complaints Procedure

Members may be practicing according to the National Competency Standards and adhering to the Code of Conduct, but things can still go wrong. For this reason, the independent Ethics Review Committees, made up of an independent Chairperson with expertise in regulation, audiology and audiometry professionals, and community representative members was established to oversee the complaints procedures for both AudA and ACAud incorporating HAASA. These procedures align with the NASRHP (and Aphra) requirements.

Most complaints are resolved through informal resolution, managed by the independent Ethics Officer. In the rare cases where informal resolution is not possible, mediation or a formal hearing and investigation may proceed.  A hearing and investigation panel is drawn from a pool of assessors by the Committee. Only complaints against past or present members of and/or clinically certified practitioners by AudA or ACAud incorporating HAASA will be investigated.  Sanctions may occur or apply if a practitioner is found to be in breach of the Code of Conduct, but these are very rare. Referral to a state-based health complaints entities and government-funding programs, where appropriate, can also occur. The Ethics Review Committees operate independently of AudA, ACAud inc. HAASA, and advises us where there is a decision about one of our members, that requires us to apply a sanction.

 

Regulation and funding models

Audiology Australia advocates for the equal recognition of allied health professionals who are members of self-regulating professions registered under the NASRHP framework and members of Ahpra registered professions.

From a standards perspective the Australian Government recognises self-regulating health professions and health professions regulated by an Ahpra Board equally. It has explicitly prohibited discrimination on the basis of whether or not a profession is regulated by an Ahpra Board.

The fact that the Government recognises self-regulating professions such as ours is evidenced by the fact that membership with AudA is sufficient to provide government-funded audiological services including:

  • The Department of Health Hearing Services Program
  • Medicare
  • The NDIS
  • State and Territory workers’ compensation schemes (such as Workcover)
  • The Department of Veterans’ Affairs

Additionally, private healthcare funds also require that the audiologist is a member of AudA for the fee to be reimbursed. AudA is routinely contacted by these organisations to confirm membership and Accredited Audiologist status of our members.

 

NRAS: what’s in it for me?

The NRAS is governed by a nationally consistent law passed by each state and territory parliament – the Health Practitioner Regulation National Law (the National Law).

The purpose of NRAS is to:

  • Ensure all regulated health professionals are registered against consistent, high-quality, national professional standards.
  • Make it easier for health professionals to work across different states and territories in Australia, as they don’t have to re-register in each jurisdiction.
  • Provide protection to the public

To be part of the NRAS, a health profession is first assessed against the six criteria set by the COAG Health Council.  These criteria are outlined in Table1 below.

A profession must meet all six criteria to be eligible to become a registered profession. If the profession meets those criteria, State and Territory Health Ministers must also agree to support the inclusion of that health profession in the NRAS. The COAG Health Council comprised of the State and Territory Health Ministers, makes the final determination as to whether a health profession is eligible to become part of NRAS.

Ahpra administers the NRAS for the 16 registered professions. Each profession has a National Board except for Nursing and Midwifery which has a shared Board. Ahpra has five core regulatory functions:

  1. Setting Professional standards.
  2. Monitoring Registration to ensure practitioners are qualified, competent and ethical.
  3. Managing complaints
  4. Monitoring compliance and auditing practitioners
  5. Monitoring accreditation of universities

 

Criteria
Criterion 1-
Is it appropriate for Health Ministers to exercise responsibility for regulating the occupation in question, or does the occupation more appropriately fall within the domain of another Ministry?
Criterion 2-
Do the activities of the occupation pose a significant risk of harm to the health and safety of the public?
Criterion 3-
Do existing regulatory or other mechanisms fail to address health and safety issues
Criterion 4-
Is regulation possible to implement for the occupation in question?
Criterion 5-
Is regulation practical to implement for the occupation in question?
Criterion 6-
Do the benefits to the public of regulation clearly outweigh the potential negative impact of such regulation?

 

Table 1: Criteria for assessing the need for statutory regulation of unregulated health occupations.  

 

Do registered professions like their scheme?

Ahpra surveys practitioners regularly on their views towards regulation under the NRAS. The latest survey in 2021 found that overall practitioner perceptions of Ahpra are 52% positive, 38% negative or mixed and 10% had no view. The survey found that Ahpra registered practitioners think the benefits of the scheme are that it:

  • Offers a nationally consistent standard of practice
  • Has a focus on Continuing Professional Development
  • Enables workforce mobility (i.e., they can practice across Australia)
  • Provides a useful online register of practitioners
  • Ensures Professional credibility

Nevertheless, many professions also report significant problems with the scheme especially with regards to the complaints process and how it can affect practitioners professionally and personally. The complaints process is limited to unsafe care and unprofessional behaviour pertaining to specific practitioners, and does not extend to organisational management, clinical processes in health settings or private practice, or the integration with other health professionals.

 

Are audiologists a risk to the public in 2024?

The Government has consistently stated that audiology is considered to be a low-risk profession as it does not undertake activities that pose a significant risk to public health and safety. Formal complaints made against audiologists are also low. For instance, in 2019-20, Health Complaints Commissioner (or equivalent bodies) annual reports indicated that there were approximately three complaints made against audiologists out of a total of over 25,000 complaints across Australia. Since its inception in July 2018, the Ethics Review Committee has received a total of 80 complaints across members of AudA, HAASA and ACaud.  Of those, 5 matters were referred to a panel for full hearing and investigation and of those 3 resulted in temporary sanctions.

Recently, the sector has had some significant instances where adverse outcomes have been seen due to a number of complex procedural and administrative issues. Together with our colleagues from the Hearing Health Sector Alliance, AudA has met with the relevant State Ministers/Ministers Advisors to ensure there is ecosystem wide response to what occurred, so that appropriate and meaningful changes can be made to prevent similar incidents occurring again. For our own part, AudA is developing further standards and accreditation requirements (as a result of recommendations from both investigations) and working with industry to mitigate any future instances of mishandling of the hearing implant space.

 

Important variables to consider

  • Providing practitioners with effective regulation and associated activities should be practical and cost effective.
  • Consistent advocacy to government on key audiological issues is already happening
  • Registration won’t change some of the fundamental issues within the health system, that are reported by both audiologists and other health professionals. Registered health professionals may face the same frustrations and challenges as audiologists, such as direct Medicare referrals
  • Registration is primarily about ensuring public safety and audiology is a “low risk” profession
  • Regulation under NASRHP is comparable to registration under NRAS, especially when core audiological practices are considered
  • If audiology is regulated with professions that are not comparable in terms of risk, numbers of practitioners, cost and key issues, we may lose the ability to respond to member concerns in a flexible and independent manner
  • All health care workers must adhere to the National Code of Conduct for health care workers, whether the profession is registered or not

 

Ahpra and NASRHP at a glance

NRASAudA Through NASRHP
Annual registration or accreditation feesVariable: $127-1500 dependant on profession and type of registration*Nil. Included in membership fees
Annual PPB membership feesVariable: $500 - $1700$625, including member benefits, CPD activities and advocacy
StandardsMandatory Professional Standards of PracticeMandatory Professional Standards of Practice
Qualified ProfessionalRegistration to practiceAccredited to practice
ComplaintsNotifications are made directly to the relevant AHPRA board with powers to enforce the Code of Conduct and issue prohibition orders pertaining to individual practitionersNotifications made via an independent ERC and investigated by independent panels. Significant concerns are notified to the Health Ombudsman. Unable to issue prohibition orders to prevent an audiologist from practicing.
Students and accrediting coursesAhpra works with accreditation authorities and committees to ensure graduating students are suitably qualified and skilled to apply for registration.AudA works with universities to accredit Audiology Masters programs in Australia. After completing the program and a clinical internship, graduates can apply to be an Audiology Australia Accredited Audiologist.
ComplianceMonitors and audits registered health practitioners to ensure they are compliantMonitors and audits audiologists to ensure they are compliant. AudA is monitored and audited by NASRP
CPD pointsCPD points stipulated and auditedCPD points stipulated and audited
CPD learningCPD education opportunities are not providedCPD education opportunities provided
Scope of PracticeScope of Practice is articulatedScope of practice is articulated
Public RegistryProvides a public register of Registered PractitionersProvides a publicly available list of Audiology Australia Accredited Audiologists
Code of ConductMandatory compliance to the professions code of conduct.

National Code of Conduct for Health Care Workers, as applied in the relevant State.
Mandatory compliance to the AudA Code of Conduct.

National Code of Conduct for Health Care Workers, as applied in the relevant State.
Criminal history checksAhpra conducts nation criminal history checks when practitioners first registers and relies on practitioners reporting any changes.AudA asks members to declare their criminal history when making a membership application and each time they renew.
English language requirementsMinimum standards required based on demonstrated competency through education or English language testingMinimum standards required based on demonstrated competency through education or English language testing.
Title protectionThe titles of registered health professions are 'protected' by law. When you see someone who uses a protected title (for example, 'medical practitioner'), you can expect that person is appropriately trained and qualified in that profession, registered, and that they are expected to meet safe and professional standards of practiceNo formal title protection
Workforce mobilityAhpra registered practitioners can work in any state or territoryAudA audiologists can work in any state or territory
Professional Indemnity InsuranceAhpra registered practitioners are required to have PIIMembers of AudA are required to have PII
National Board oversightEach profession has a National Board that provides oversight. Their primary role is to protect the public, but they also register practitioners and students. Boards are supported by Ahpra in the framework of a Health Profession Agreement.Governed by the Board of Directors who has the responsibility of making effective decisions in the best interests of the profession.

The Board sets our mission, vision, values and strategic direction and certification requirements.
HSPApproved provider (assumption)Currently eligible to obtain a QP number if AudA member
Medicare ClaimsApproved providersApproved providers if AudA Accredited member
NDISApproved providersApproved providers
S&T Workers Compensation SchemesApproved providersApproved providers if AudA member
Veteran AffairsApproved providersApproved providers
Private HealthApproved providersApproved providers if AudA member

* Registration fees are set by the relevant Board and Ahpra and vary between professions based on the cost of regulating each profession under the National Law. The fees vary depending on factors such as the size of the profession, the risks associated with practice, the level and complexity of complaints and notifications, and the capital reserves needed to ensure sustainability of the operations of the Board. The National Law requires that registration fees are reasonable having regard to the efficient and effective operation of the National Scheme. An additional application fee is payable on initial registration.

 

References

  1. Australian Health Workforce Ministerial Council. 1 April 2010- AHWMC Communique. Health Ministers announce approval of national health practitioner registration standards. 2010.
  2. Commonwealth of Australia. Intergovernmental Agreement for a National Registration and Accreditation Scheme for the Health Professions. 2008.
  3. COAG Health Council. Communique 8 April 2016.
  4. Australian Health Ministers’ Advisory Council. Final Report- Independent Review of the National Registration and Accreditation Scheme for health professions. 2014 Dec.
  5. COAG Health Council. Communique- The Independent Review of the National Registration and Accreditation Scheme for Health Professionals. August 2015.
  6. https://www.ahpra.gov.au/News/20230626-Ahpra-and-National-Boards-release-social-research-results.aspx
  7. https://www.ama.com.au/articles/ahpra-data-confirms-traumatic-effect-regulatory-process-doctors-and-need-change

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