Australia’s healthcare system was founded on a principle of balance. On the idea that trust, accountability, and fairness could coexist. Regulators would protect patients. Hospitals would support their staff. And those working on the frontlines could rely on due process when things went wrong.
That remains the goal. Yet today, many clinicians describe a system where the mechanisms of accountability can, at times, be experienced as mechanisms of harm. Not because regulation itself is flawed, but because of how it is sometimes used and by whom.
The complaint process under Australia’s regulatory framework (including the Australian Health Practitioner Regulation Agency – AHPRA) is essential to maintaining public trust.
It provides a pathway to address safety and professional concerns transparently. However, growing evidence suggests that these pathways can also be misused. Not for reasons of safety, but for reasons of internal politics, personality conflict, or institutional expedience.
The 2024 review by the National Health Practitioner Ombudsman (NHPO) recognised this challenge. It warned that a small number of vexatious or bad-faith complaints can cause “serious psychological, financial and professional harm” to practitioners. The Ombudsman’s findings prompted a series of reforms, many of which aimed to strengthen protections, improve triage, and increase transparency.
These steps are critical. Yet the deeper issue lies not with the regulatory framework alone, but with the organisational cultures that have learned how to use it -or misuse it.
Institutional Anonymity and the “Corporate Shield”
Hospitals and health services can lodge complaints to AHPRA as organisations, but often without identifying the individuals behind them. This anonymity can create what some describe as a “corporate shield” – one that protects the institution while leaving the individual practitioner fully exposed.
Once a notification is made, the practitioner’s name becomes associated with the complaint, but the origin of the allegation and therefore the accountability on the part of those who made it remains quite opaque. This imbalance raises governance and ethical concerns.
Under the National Safety and Quality Health Service (NSQHS) Standards, healthcare boards are accountable for ensuring fair and transparent complaints processes. Yet when matters escalate to the regulatory level, that fairness can sometimes become obscured by this type of organisational self-protection.
The Chilling Effect on Whistle-blowers
Some of the most troubling cases involve clinicians who raise legitimate concerns about safety, bullying, or unethical practices, who then find themselves subject to counter complaints often in retaliation. In these situations, our regulatory mechanisms may be unintentionally co-opted to silence, rather than protect.
This dynamic undermines obviously the culture of openness that modern health governance depends on. When clinicians begin to associate speaking up with personal risk, the whole system loses a layer of protection for patients.
Unequal Protections in Private Practice
This issue can be particularly pronounced in private hospitals, where many doctors practise as Visiting Medical Officers (VMOs) rather than employees. As contractors, VMOs generally lack unfair dismissal or whistle-blower protections and often can have their privileges revoked with little procedural recourse.
Some private hospital by-laws even allow privileges to be withdrawn “at any time, for any reason.” In practice, this gives institutions broad discretion and can leave doctors vulnerable to administrative or reputational action, with limited avenues to respond.
Hidden Bias and Blind Spots
Data and anecdotal reports continue to suggest that certain groups of practitioners still face disproportionate scrutiny. Clinicians from culturally diverse backgrounds, women, and older practitioners appear to be over-represented in certain types of complaints.
These patterns highlight a broader challenge: a level of hidden bias that may be embedded within our systems of evaluation and reporting. Because demographic data on complaints is not routinely collected, systemic inequities remain difficult to detect or address.
As the NHPO observed, inequity cannot be remedied if it remains invisible.
Shared Responsibility for Fairness
Although the National Law allows complaints that are frivolous or vexatious to be dismissed, there still exists no penalty or adverse consequence to those responsible which then fails to curb ongoing misuse of the system. The responsibility for preventing misuse extends well beyond AHPRA though. Employers, boards, and executives all play a role in how complaints are initiated, framed, and supported.
Fairness in regulation depends on fairness in governance. Institutions that use regulatory pathways as instruments of control risk damaging not only individual clinicians but also their own cultures of trust and transparency.
Five Reforms to Restore Fairness
1. Shared accountability – Require that all hospital-initiated notifications be authorised by both the CEO and Board Chair, confirming that the complaint is evidence-based and non-retaliatory.
2. Faster resolution – Enable early triage and closure of clearly unsubstantiated complaints within 21 days, with transparent reporting of outcomes.
3. Consequences for misuse – Introduce penalties or accreditation impacts for those found to have misused complaint mechanisms for retaliatory purposes.
4. Fairness for contracted clinicians – Extend whistle-blower and procedural fairness protections to independent practitioners such as VMOs.
5. Transparency and data – Collect and publish de-identified demographic and source data on complaints to reveal patterns of bias or inequity.
The Leadership Imperative
Ultimately, this is not just a regulatory challenge, it is a leadership one. Health boards and executives must examine how their complaint processes are being used and whether they truly align with the principles of fairness and transparency.
We must all ask ourselves:
- Are our complaint systems fair and transparent?
- Do we protect people who speak up or silence them?
- Are we confident that internal complaints are free from bias or ulterior motive?
The NSQHS Standards make this obligation clear: boards are accountable for clinical governance, organisational integrity, and the culture that underpins both.
When fairness disappears, trust erodes within teams, within organisations, and across the health system. Rebuilding that trust requires every part of the system, regulators, boards, executives, and clinicians, to share responsibility for ethical and transparent complaint management.
Australia now has the opportunity to lead globally in regulatory fairness by creating a model that protects patients and practitioners alike, grounded in compassion, accountability, and shared trust.
Until hospitals, regulators and all of us as healthcare leaders commit to this level of accountability, we will keep losing good doctors. Not to incompetence, but to injustice.
For more healthcare industry analysis and thought leadership content follow AIHE on Linkedin.
