Claims insights: hospital-based early career doctors

Overview

Practice points

Avant’s Medico-legal Advisory Service provided vital support and guidance to hospital-based early career doctors during the COVID pandemic and continues to do so today. Regulatory complaints accounted for the largest share of medico-legal matters, followed by employment disputes. Practitioner behaviour was a significant issue in complaints, particularly relating to health impairment and communication. Other common concerns included prescribing and patient management (residents) and surgical-related issues (registrars). In more than 50% of regulatory complaints, early career doctors were found to have met the expected standard of care. Where the standard of care was not met, risk intervention strategies helped reduce the severity of outcomes.

As doctors progress through hospital training and assume greater responsibilities, they are more likely to receive complaints relating to communication, procedural skills and patient boundaries. Take patient concerns seriously and respond promptly. Communicate proactively with patients to understand and address their concerns. Manage patient expectations for procedures through clear communication, realistic examples of outcomes, and a thorough consent process. Document all discussions carefully. Do not let concerns about impairment-related complaints prevent you from seeking healthcare when you need it. Complaints are uncommon at this stage of your profession, and prioritising your health is always the safest course of action.

^{Incidence and types of matter are based on all matters indemnified by Avant for early career doctors from FY 2021-25. Underlying themes and outcome of complaints are based on regulatory complaints closed from FY 2019-25.}

Hospital-based early career doctors are covered by their hospital for civil liability for patient injury, while Avant provides cover for other medico-legal matters including regulatory complaints, employment and training disputes, coronial matters, and other issues. Avant members also have access to Avant’s Medico-Legal Advisory Service (MLAS) for expert guidance and support when challenges arise. 

Medico-legal calls

MLAS received an average of 1800 calls from hospital-based early career doctors each year with volumes rising to more than 2000 calls during the COVID pandemic.

Most common topics discussed

1. Clinical issues (e.g. treatment-related incidents/adverse events, COVID-related, patient relationships, medical records, confidentiality)
2. Employment concerns (e.g. employment disputes, contracts)
3. Patient complaints (e.g. responding to complaints)
4. Court documents and requirements (e.g. responding to subpoenas for medical records) 
5. Coronial matters (e.g. preparing a coronial statement).

The above review is based on an analysis of MLAS calls from hospital-based early career doctors from FY2021-25. 

Annual incidence* of hospital-based early career doctors who had a medico-legal matter and the types of matters

Most common themes in regulatory complaints

Interns	Residents (PGY2+)	Registrars
65% Practitioner behaviour e.g. allegations of impairment (mental or psychological)	27% Practitioner behaviour e.g. allegations of impairment (mental or psychological, substance abuse), communication issues	30% Practitioner behaviour e.g. communication issues, impairment (mental or psychological, substance abuse), patient boundary issues
	18% Medication e.g. inappropriate prescribing of drugs of dependence and other medication, self-prescribing	14% Procedural/surgical e.g. poor performance/skill/competence in relation to specific procedures or surgeries
	18% Management/treatment e.g. complaints about provision of treatment (inadequate or no examination, treatment plans)

Regulatory complaints outcomes for hospital-based early career doctors overall

• More than half of complaints (54%) were considered to have met the standard of care. Of these, nearly all were finalised with no further action.
• Less than half of complaints (46%) were assessed to not meet the standard. One-third was finalised with no further action with risk management intervention contributing to this outcome. Other cases had either low severity (42%) or medium/high severity (25%) outcomes.

Notes

This analysis was conducted on regulatory complaints made against hospital-based early career doctors closed from July 2018 to June 2025. Only complaints that were risk assessed and with a known outcome were included.

a) No further action may have been taken despite a below standard of care assessment. This outcome would  have considered the actions already carried out by the member including proactive risk management interventions made or education such that there is no future risk.

b) In some cases, a practitioner who has met the requisite standard of care may agree or be required to go through an additional process, such as a conciliation, for the parties to discuss concerns and explore mutually acceptable resolutions.

Glossary

1. Matters include claims, complaints, coronial cases and other matters such as employment disputes and Medicare.
2. Claims refers to claims for money, compensation and civil claims.
3. Complaints relates to formal complaints to regulators including Ahpra, HCCC in NSW and OHO in Queensland.
4. Employment disputes are matters where Avant defends members against complaints or supports members to resolve employment issues.
5. Training disputes are disagreements that arise during a doctor’s vocational training, involving their training provider, hospital, or a supervisor, assessor, or reviewer.

More information

If you receive a claim or complaint, contact us on 1800 128 268 for medico-legal advice on how to respond- available 24/7 in emergencies.

Avant’s Risk Advisory Service provides personalised support to help proactively reduce your exposure to claims. You can benefit from a personalised risk assessment with a focus on strategy to improve your medical records. Contact us at Risk.Advisory@avant.org.au Risk.Advisory@avant.org.au or visit Risk Advisory Services - Avant.

Visit our Insights & Resources page for further educational content including webinars, eLearning courses, case studies, articles and factsheets.

Useful resources:

Completing a death certificate

Coronial investigations and inquests

Early career doctors – managing complaints matters

Health and well-being support for Avant members