Endorsement and specialist registration

Difference between area of practice endorsement and specialist registration

Specialist registration and area of practice endorsement are both mechanisms under the National Law that identify practitioners who have undertaken additional qualifications. The Ministerial Council is responsible for approving specialties and protected specialist titles, and for approving areas of practice for endorsement and their relevant protected titles, for each health profession.

The difference between area of practice endorsement and specialist registration as regulatory tools is about the level of risk to the public. The main differences are:

1. Specialisation is considered to pose a higher level of risk to the public than endorsement. Only three health professions have specialist registration in Australia – medicine (e.g. anaesthesia, surgery), dentistry (e.g. orthodontics, oral surgery), and podiatry (e.g. podiatric surgery).
   
   
2. An endorsement is a notation on general registration and published on the National Register while specialist registration is a separate register and requires a higher level of regulatory oversight. 
   
   
3. Area of practice endorsement allows for more flexibility than specialisation. Area of practice endorsement builds on general registration and psychologists can hold more than one endorsement, allowing for flexibility in work. Health practitioners who are on the specialist register typically work in a specific and defined higher-risk specialist area, and only work in that specialist area. For example, a medical practitioner on the specialist register might work as an anaesthetist or a neuro-surgeon, but not usually as both. Psychologists on the other hand, tend to work in different roles and contexts over a career, can hold more than one endorsement, and psychologists with different endorsements might work in the same work context (e.g. both a clinical psychologist and an education and developmental psychologist might conduct child assessments).

In 2014 the Ministerial Council issued guidance to National Boards about the criteria for the approval of specialties for the purpose of specialist registration in a health profession. The Ministerial Council guidance makes it clear that approval for specialist registration is a 'regulatory instrument' within the meaning of the Council of Australian Governments Best Practice Regulation. It requires a robust regulatory assessment process be carried out before Ministerial Council decision with oversight by the Office of Best Practice Regulation. This assessment must prove that:

• that current risks in the profession are not being managed by the current arrangements, and
• that specialist registration is the appropriate remedy (rather than some other mechanism or process) to control those risks.

In considering this guidance, the Psychology Board of Australia determined that the ‘case for action’ had not been made for submitting the psychology profession and the public to the increased regulatory burden of specialist recognition under the National Law. Endorsement has provided a legal mechanism within the National Scheme to regulate psychologists with additional training in a proportionate way without unnecessarily restricting scope of practice.