The Australian Medical Board: transparency and accountability?

by Dr Antony Ji, AMA Queensland Committee of Doctors in Training Industrial Relations Lead

Compare this with the modest $185 fee charged to nurses and midwives, whose regulatory body has announced a freeze on fees for 2024–25. The stark disparity invites scrutiny - not only into the financial workings of the Medical Board of Australia but also into its priorities.

The nursing and midwifery board openly communicates its commitment to keeping fees low while ensuring public safety. Yet for doctors, the cost of registration has escalated far beyond inflation, with no accompanying explanation. The silence is deafening. For a board that claims to act in the public interest, transparency about finances should be a given. Instead, the Medical Board appears shrouded in opacity. How much are board members paid? What proportion of registration fees funds essential services versus administrative overhead? These are not unreasonable questions, and they demand answers.

Adding to the frustration is the role of the Australian Medical Council (AMC), which accredits medical schools, specialist colleges, and training programs. While its functions are critical, the AMC is, at its core, a business. A business that has reaped a large financial gain from the recently implemented CPD Homes initiative - something unique to the medical profession. This raises the provocative possibility: should the colleges themselves band together to create a competing accreditation authority? The idea is not far-fetched. Competition could force the AMC to improve its practices and justify its fees. A monopoly is rarely a driver of efficiency, and the AMC’s dominance may be ripe for disruption.

A seismic shift in specialist registration

If the escalating costs of registration are troubling, the Medical Board’s recent policy moves are downright alarming. Under a new “expedited pathway,” international specialists with qualifications on a pre-approved list can bypass traditional assessments by Australian medical colleges to gain specialist registration. This development has sent shockwaves through the medical community- and for good reason.

The board’s mission is to regulate in the public interest, but its actions seem to disregard the voices of the very professionals it regulates. Resident doctors and specialists alike have raised concerns about the policy’s potential impact, yet their outcry has been met with silence. The implications for Australia’s healthcare ecosystem are profound.

For one, the influx of externally accredited specialists will exacerbate job scarcity for resident doctors and registrars, who already face stiff competition for training positions. More troublingly, these specialists are not bound by the educational requirements enforced by colleges. Unlike college-trained practitioners, they are not obligated to contribute to the training and mentoring of the next generation. Over time, this could erode the culture of teaching and collaboration that underpins Australia’s healthcare system.

Furthermore, the expedited pathway risks introducing specialists who may lack familiarity with the nuances of Australian medical practice. While diversity in the workforce is invaluable, it must not come at the expense of rigorous training and consistent standards. Allowing non-college specialists to operate indistinguishably within the health system could blur the lines of accountability and dilute the quality of care.

The Medical Board - a crisis of legitimacy

At its core, the Medical Board’s actions raise a fundamental question: does it still act in a manner that considers the views, situations, and experience of the medical experts it regulates? Increasingly, the answer seems to be no. Its financial practices and policy decisions suggest an institution out of touch with the professionals with whom it forms its relationship, and an ignorance, wilful or otherwise, of the unintended consequences and trajectories it seeks to imitate globally. 

When any governing body loses the confidence of its constituents, history tells us that change becomes inevitable. Revolutions, after all, often begin with words. The medical profession must consider whether it is time to demand more accountability and, if necessary, a change in leadership. Doctors do not object to regulation; they object to bad regulation. The board’s primary mandate is to protect the public, not to enact policies that undermine the profession’s capacity to deliver high-quality care.

The Medical Board must also remember that its legitimacy derives from trust. Its power is not absolute; it is granted by the community it serves. The board’s recent actions - opaque financial practices, fee hikes, and contentious policy shifts - are eroding that trust. Without swift course correction, the Medical Board risks becoming an institution that protects neither the public nor represents the profession.

With great power comes great responsibility. The Medical Board of Australia has been entrusted with the regulation of a profession that is vital to public health. This is not a responsibility to be taken lightly. Its financial and policy decisions must reflect a commitment to transparency, accountability, and the views of the medical community.

Perhaps it is time for doctors to borrow a page from history’s playbook. Writing - whether open letters, opinion pieces, or formal petitions - can be a powerful tool for change. If the board continues on its current trajectory, it may start to become the medical profession’s duty to protect the public from the Board itself. After all, the board exists to ensure the safety of the public and competence of medical practitioners but to fulfil that role, it must first get its own house in order.

Perhaps a reckoning is overdue. Let it begin with the doctors who have had enough.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the views or positions of AMA Queensland.