Simply declaring an interest will not necessarily resolve a conflict.
AHPRA’s updated guidance puts financial interests and referral arrangements under the spotlight, but a medicolegal expert says disclosure alone may not be enough.
Doctors who benefit financially from referring patients to pathology providers, imaging services or other healthcare businesses must be upfront about those arrangements, with new AHPRA guidance reinforcing that patient welfare must come before commercial interests.
The regulator has released interim guidance on managing financial and commercial conflicts of interest, reminding practitioners of their obligations to identify, disclose and appropriately manage interests that could influence clinical decision-making.
The update comes as AHPRA and the National Boards undertake a broader review of professional codes of conduct.
Miga’s Head of Claims and Legal Services Anthony Mennillo said that the guidance was a timely reminder for doctors to examine their financial arrangements, particularly as medical practices increasingly operate alongside pathology, imaging and allied health businesses.
“Fundamentally, this is always about maintaining patient trust,” he said.
“The overarching principle is that the patient is at the centre of this, and that their health and wellbeing should be at the forefront of decision-making, and not some ulterior benefit that you may or may not receive.”
Mr Mennillo said the guidance did not introduce an entirely new obligation, with conflicts of interest already addressed in professional codes of conduct.
Rather, it reinforced existing expectations while the broader review was underway.
The issue was particularly relevant to practices with co-located services, where financial relationships between medical practitioners and other healthcare businesses might not be obvious to patients.
Mr Mennillo said doctors who received a financial benefit from referring patients to an associated pathology or imaging provider needed to disclose that interest and explain that patients were free to attend another service.
“If the practice, and in particular the practitioner, receives any financial benefit arising from the presence of the pathology provider within the same premises, this should be disclosed to patients,” he said.
However, simply having a pathology collection centre next door to a consulting room did not necessarily create a conflict.
There might be no financial arrangement between the businesses, with the co-location existing purely for patient convenience.
But where the practitioner or practice benefited financially from referrals, the relationship needed to be made clear.
“You should know that this [allied health] service operates from the same premises as our practice, and the practice receives a financial benefit from that arrangement. You are under no obligation to use this provider, and can attend any other provider if you wish,” Mr Mennillo said, giving an example of how the disclosure might be communicated.
Depending on the circumstances, a clearly displayed notice in the waiting room could potentially provide adequate disclosure, rather than requiring doctors to repeat the same explanation whenever a patient needed a blood test.
Relevant disclosures should also be documented in the patient’s medical record, Mr Mennillo said.
Importantly, he said doctors needed to recognise that simply declaring an interest would not necessarily resolve a conflict.
“Disclosure is one part of it, but it may not be enough,” he said.
Patients needed to understand the nature of the practitioner’s interest, whether appropriate alternatives existed and that they had a genuine choice about where to receive treatment or services.
While direct referral payments or ownership interests were relatively straightforward examples, Mr Mennillo said indirect benefits could create more difficult questions.
“The further removed the practitioner is from the benefit, that creates the greyer areas,” he said.
For example, a doctor might own premises leased to a pathology provider, receiving rental income from the business without receiving any direct payment for referrals.
Alternatively, a practitioner might receive an end-of-year bonus or other benefit that was not explicitly linked to individual referral decisions.
Such arrangements might not always require the same level of disclosure, but Mr Mennillo said practitioners should seek advice where their obligations were unclear.
At the other end of the spectrum were specialists who had a direct financial interest in the products they recommended.
Mr Mennillo used as an example orthopaedic surgeons who had helped develop particular implants and subsequently received financial benefits from their use.
In those circumstances, doctors needed to explain their involvement and financial interest to patients, as well as discuss available alternatives.
Mr Mennillo said in his experience, regulators had often focused on educating practitioners and improving their processes rather than immediately pursuing disciplinary sanctions.
However, he believed the updated guidance indicated a clearer regulatory expectation around compliance.
“Now AHPRA are making things a lot clearer in the guidelines and saying, well, if you don’t comply, now we’re going to take action,” he said.
The obligations also intersected with existing advertising requirements, particularly where doctors promoted products or services in which they held a financial interest.
Mr Mennillo said most practitioners would not need to fundamentally change how they worked but should review arrangements that could give rise to actual or perceived conflicts and seek advice if there is any uncertainty.
For doctors uncertain about whether a particular relationship warranted disclosure, he recommended applying what he called the “front page test”.
“Would I be comfortable if this arrangement appeared on the front page of a newspaper?” he said.
If the prospect of that arrangement or relationship becoming public made the practitioner uneasy, it was probably a sign that disclosure was appropriate.
Doctors unsure of their obligations should seek advice from their medical defence organisation, he added.
“For most doctors, this updated guidance won’t require a fundamental change to the way they practice,” Mr Menillo said.
“But the key message is to keep patient welfare at the centre of decision-making. Transparency about financial interests, discussing alternatives, and documenting the conversation.
“Essentially, that’s what maintains patient trust, which is what the Board is ultimately considering.”
