Every profession requires regulation. Doctors, nurses, psychologists and other health practitioners wield enormous influence over people's lives. Patients need confidence that incompetent, impaired or unethical practitioners can be investigated and, where necessary, removed from practice. That is why Australia created the Australian Health Practitioner Regulation Agency (AHPRA). In principle, its mission is entirely reasonable: protect the public.

The problem is that every regulator eventually faces the same temptation. Having been given significant powers to pursue a worthy objective, it gradually accumulates more authority, more discretion and less accountability. At some point, the institution charged with policing others begins to escape effective policing itself.

This concern was at the heart of a conference discussed by Dr Julie Sladden in The Spectator Australia, where doctors, lawyers, academics and patients argued that AHPRA has become "unfit for purpose." The participants contended that the system is failing not only practitioners but also the patients it was created to protect.

One of the recurring criticisms concerns accountability. Unlike many government agencies, AHPRA occupies a complex national regulatory structure. Critics argue that there is no single minister directly responsible for its day-to-day performance, that oversight mechanisms have limited powers, and that those subjected to lengthy investigations often have little practical recourse when delays or procedural problems occur.

Delay itself is not merely an administrative inconvenience. For a health practitioner, an unresolved investigation can mean years of uncertainty, reputational damage, financial stress and emotional strain. Even where allegations are ultimately dismissed, the process may have inflicted severe professional and personal costs long before any final determination.

One of the most tragic cases discussed at the conference was that of Adelaide obstetrician Dr Yen-Yung Yap, who died by suicide while under investigation by AHPRA. His widow addressed the conference, highlighting the devastating human consequences that regulatory processes can sometimes have. The article also referred to reports that multiple practitioners involved in AHPRA processes attempted or died by suicide during recent years. These cases have intensified calls for reform while reminding everyone that regulatory systems must consider not only patient safety but also procedural fairness and practitioner wellbeing.

None of this means that AHPRA serves no useful purpose. Far from it.

Australia undoubtedly needs an independent body capable of investigating serious allegations of professional misconduct, protecting patients from dangerous practitioners and maintaining professional standards. Without such a regulator, public confidence in the health professions would suffer.

Indeed, AHPRA continues to perform important regulatory functions. It has successfully prosecuted unregistered practice, enforced mandatory information requests and introduced new safety standards in areas such as cosmetic procedures.

The real question, therefore, is not whether Australia should abolish regulation. It is how regulation itself should be regulated.

History repeatedly demonstrates that institutions created for noble purposes often develop organisational cultures that prioritise procedural self-preservation over the people they exist to serve. Police oversight bodies require oversight. Anti-corruption commissions require oversight. Intelligence agencies require oversight. Courts themselves are subject to appeal. Why should professional regulators be any different?

Recent independent reviews of Australia's health profession regulation have themselves acknowledged the need for reform. Among the recommendations are stronger governance, improved complaints handling, greater procedural fairness, more timely investigations and consideration of legislative changes to strengthen review rights and accountability.

Importantly, criticism of AHPRA should not be confused with defending every practitioner who comes before it. Some practitioners undoubtedly deserve disciplinary action or removal from practice. Serious misconduct exists. Public protection remains paramount.

But justice has two inseparable components.

The first is protecting patients from dangerous practitioners.

The second is protecting practitioners from unjust processes.

A regulator succeeds only when it accomplishes both simultaneously.

The philosophical lesson extends well beyond medicine. Every bureaucracy faces what might be called the "institutional paradox." Organisations created to solve one problem often become new sources of problems themselves. The solution is not necessarily abolition. Rather, every concentration of power requires corresponding mechanisms of transparency, review and accountability.

The old Roman question remains as relevant today as ever: Quis custodiet ipsos custodes? Who guards the guards themselves?

That question is not anti-regulation. It is the very foundation of constitutional government. Power without accountability eventually ceases to protect liberty and begins to threaten it. The challenge for Australia is to ensure that AHPRA remains what Parliament intended it to be: a guardian of public safety, not an institution beyond meaningful scrutiny.

Protecting patients and protecting procedural justice are not competing goals. They are complementary principles. A regulator worthy of public confidence must be capable of achieving both.

https://www.spectator.com.au/2025/06/ahpra-unfit-for-purpose/