As Australia slowly edges closer to developing national registration for core health and medical professions, it seems that one important group of health professionals is missing from the discussions.
Registration schemes have traditionally been designed to protect the public in their interactions with clinicians, whether doctors, nurses or dentists.
What we lack are safeguards for ensuring the work of public health professionals — who tend to work in government, NGOs and academia — does not jeopardise public safety.
It could be argued that public health professionals, because of the wide-reaching impact of their decisions, have at least as great an impact on the public’s health as any individual clinician.
The Council of Australian Governments (COAG) has decided that the nine health occupations that currently have statutory registration requirements in all states and territories (nursing, medical, physiotherapy, psychology, optometry, chiropracty, osteopathy, several dental professions and pharmacy, with podiatry to be added soon) will be included in a national registration and accreditation scheme for health professionals.
Consideration is also being given to including several other partially regulated health occupations in the registration and accreditation scheme. These include: Aboriginal and Torres Strait Islander health workers, dental technicians, occupational therapists, medical radiation practitioners, speech pathologists, Chinese medicine practitioners and optical dispensers.
Up until now, each Australian state and territory has run its own registration schemes, with variation among the states and territories as to which professions are registered and the details of registration requirements. The COAG decision aims to promote national consistency and remove unnecessary red tape and confusion for the registration processes, individual health professionals and members of the public.
So, is now the time for public health professionals to enter the registration fold? For the most part, public health workers do not interact with individual patients or individual members of the public, and do not provide individual advice, investigation or treatment.
But they do have the potential to affect the lives and wellbeing of individual members of the public — indeed, this is usually exactly what public health workers are seeking to achieve.
In fact, public health workers are often seeking to change the lives of many more individuals in the community than an individual clinical colleague might do in months of practice, often in much more significant ways.
But what guarantee does the public (or employers) have that individual public health workers are competent? How do we know that their practice isn’t as tainted and dangerous as the practice of some doctors who have made the headlines in recent years?
Patients sometimes sue clinicians, particularly doctors, not only if they have been diagnosed wrongly or prescribed the wrong drug or operated on carelessly, but also if they feel they have been given poor advice that led to harm.
When was the last time a public health worker was sued for giving poor advice to the community that led to collective or personal harm? Or, sued for failing to give good advice or to get the law or policy changed in well-proven health promoting ways?
For sure, many public health workers have undergraduate and/or post-graduate university degrees but how many of those are directly relevant to, and ensure basic competence in, the practice of public health?
Are we even confident that all the Masters of Public Health degrees around Australia turn out high quality graduates who have developed adequate knowledge and skills across the range of subjects required to ensure competency and safety in the practice of public health?
And how do we know that initially competent public health workers maintain their knowledge and skills, and develop new ones as situations change?
A strong case can be made including public health workers in the next tranche of professions to be included in the national registration and accreditation scheme.