A comparative study of the medical scientist profession in Australia and around the world to provide evidence for a review of the current self-regulatory framework.

Abstract

In 2010 the Australian Government established the Australian Health Practitioner Regulation Agency (AHPRA) to oversee the registration requirements of fifteen healthcare professions. The official reason reported for the exclusion of Medical Scientists and technicians was that these laboratory personnel do not impact patient outcomes significantly and are sufficiently regulated by laboratory accreditation and the oversight of a Registered Pathologist. The Australian Institute of Medical and Clinical Scientists and the other pathology societies have communicated with the government on several occasions asking for a review of this decision. In early 2020 a global pandemic provided a unique opportunity for the leaders of the Pathology industry in Australia to promote the work of Medical Scientists as pathology testing is the only definitive method to ascertain a patient’s COVID status. However, in Australia there has been very little mention of Medical Scientists in a public forum. This document aims to address the main reasons that the Australian Government continues to be disinterested in the recognition and importance of Medical Scientists in the healthcare system of the country. To better understand the advantages and disadvantages and provide possible recommendations for addressing these, the initial chapters describe the regulation of pathology laboratory workers in various countries. A close look at the common misconception that pathology testing influences approximately 70% of all clinical outcomes follows, finding in fact, this statement has no scientific basis. Therefore, following collaboration with colleagues a review of clinical guidelines for the most common cause of death around the world, Cardiovascular disease (CVD), was conducted. The analysis found that the accepted guidance recommends pathology testing in closer to 80% of all cases of CVD and 94% of suspected cases in Australia. When coupled with nearly 100% of all cancer diagnoses and transfusions this shows definitively for the first time that laboratory testing has a considerable impact on patients’ outcome. The other argument that is used by the Pathology industry leaders in Australia is that a registered Pathologist is sufficient to address any issue that might occur within a laboratory. Internationally, developed nations have recognised that this is not the case and seek to regulate the scientist workforce to ensure that the public are properly protected by appropriately addressing incidents and implementing robust change. Unfortunately, analytical errors occurring in Australian laboratories that have been poorly investigated and therefore provide little apparent impetus for improvement. To support recommendations in the present study two surveys were conducted, initially of a group of international laboratory workers from a large group of countries working in a hospital in Qatar and a small number of Australian respondents. Responses to the first survey were analysed and the themes of professional impact and personal implications of regulation were used to design a more focused survey for a larger group of Australian Medical Scientists. The results showed that the profession was under-recognised in Australia because of the lack of professional registration, however, further regulation to improve this did not have universal support. The most dramatic responses were to the question in the second survey about the impact of the COVID-19 pandemic on the workforce in Australia. These highlighted a workforce under extreme pressure suffering burnout and exhaustion, with misguided recognition of their contribution to the nation’s pandemic response being happily accepted by the other healthcare professions. In Australia, AHPRA as the governmental regulatory body for those nationally recognised healthcare professions and works with the leaders of these professions to maintain an official register of practitioners. The duty of monitoring individual Continuing Professional Development (CPD) and disciplinary measures are given over to the respective governing body which are mandatory to hold a practicing licence. At the highest level the National Pathology Accreditation Advisory Council (NPAAC) provide policy expertise to the Department of Health for the management of the Pathology service in Australia. As such this body provides occupational definitions, qualification requirements and employment controls which are largely currently not applied to Medical Scientists or are industrially irrelevant. This lack of recognition is likely to have a negative effect on the recognition of the importance of Medical Scientists in diagnostic laboratories and provision of pathology reports, at a time when their role and responsibilities are increasingly highlighted. It is the purpose of this thesis to highlight current deficiencies in the regulation management of this group of workers in this dynamic industry and suggest appropriate recommendations that will hopefully raise awareness of the profession in Australia.