Medical Workforce Issues in Australia: Tomorrow's Doctors - Too Few, Too Far

The Australian medical workforce, like those of most developed countries, is increasingly feminised and exposed to the global market for doctors. Demand for healthcare services is increasing in the Australian community. Concern in relation to doctor shortages is increasing, particularly in rural areas. There should be greater flexibility for entry of highly-trained overseas doctors. There is an urgent need to increase medical school student intake. Issues of workforce practice, including task substitution, should be explored

Tomorrow's Doctors: Review of The Australian Medical Workforce Advisory Committee (AMWAC)

The aim of this Review, prepared under the auspices of the Australian Health Ministers' Advisory Council, is to 1. Assess AMWAC's performance to date against its original terms of reference and assess to what extent have expectations been achieved? 2. Assess and make relevant recommendations on future national medical workforce planning needs, taking account of the relationship between the medical workforce and other health professionals and support staff, and AHMAC's decision to establish the Australian Health Workforce Advisory Committee (AHWAC); and the relationship between workforce and broader health systems issues. 3. Assess and make relevant recommendations on the suitability of AMWAC - including its structure and methodology - for meeting future medical workforce planning needs, taking account of access to and utilisation of evidence-based data; need for independence and access to broadly sourced advice; international experiences; and current issues, including the changing medical workforce; the implications of the application of the Trade Practices Act 1974 and competition policy; and corporatisation of medical practice. 4. Consider and recommend on appropriate financial commitment by AHMAC to medical workforce planning

Ageing medical workforce in Australia - where will the medical educators come from?

Background: As the general practitioner and specialist medical workforce ages there is likely to be a large number of retirees in the near future. However, few Australian studies have specifically examined medical practitioner retirement and projected retirement patterns, and the subsequent impact this may have on training future health care professionals.\ud \ud Methods: Extracts from the Australian Medicare database and Medical Labour Force Surveys are used to examine trends in attrition of general medical practitioners and specialists over the age of 45 years from the workforce and to predict their rate of retirement to 2025.\ud \ud Results: The general medical practitioner workforce has aged significantly (p<0.05). Between the years 2000 and 2025, it was projected that 43% of the year 2000 general practitioner workforce and 56% of the specialist workforce would have retired.\ud \ud Conclusion: The ageing of the baby boomer and older cohorts of the general practitioner and specialist workforce will lead to a significant number of retirements over the next 20 years. Increasing the numbers of students and new medical schools has been heralded as a means of alleviating service shortages from about 2015 onwards; however, the retirement of a large proportion of experienced health care professionals may lead to shortages of educators for these students

Augmenting the rural health workforce with physician assistants

Health workforce shortages are a global phenomenon and Australia is no exception. Deficiencies are particularly pronounced in general practice, dentistry, nursing and key allied health fields.1,2 Even with the Australian health workforce growing at close to double the rate of the population and despite an increase in medical schools and student numbers, the shortage continues to worsen due to factors such as reductions in work hours, increasing urbanisation and the ageing and feminisation of the workforce.2 A 2005 prediction by the Australian Medical Workforce Advisory Committee estimated a shortage of between 800 and 1300 general practitioner graduates alone by 2013.2 The ageing of the health workforce, increasing life expectancy and the mounting burden of chronic disease are major problems facing all developed nations. Compounding these issues in Australia are the difficulties of caring for significant rural, remote, and Indigenous populations. National and international trends suggest that the shortage and maldistribution of doctors in rural areas is very likely to worsen.2,3 As well, Australia has an increasing reliance on international medical graduates, which poses major moral questions among other dilemmas. Clearly there is a need for change in policy and service delivery models. Simply increasing the number of doctors will not necessarily improve recruitment or retention in general practice and geographically disadvantaged areas. According to Queensland Health there is considerable and ongoing difficulty in recruiting new doctors to rural and remote locations, resulting in a less than adequate rate of replacement for retiring doctors. Many health care advocates and organisations have suggested a variety of innovations to facilitate the needed transformation in the existing system. In 2007 The National Rural Health Alliance (NRHA) declared: We need to redesign the workforce so that services we currently see as ‘medical’ or ‘nursing’ are provided by a broader range of professionals than just doctors and nurses. We will get around the unavoidable shortage of doctors and nurses (given the excessive and escalating level of demand) by redesigning and redistributing the way doctoring and nursing are provided.4 This paper will outline how the introduction of physician assistants (PA) into Australia, may be one strategy to strengthen the health care team and address medical workforce shortages, especially in rural and remote areas

Integration of overseas-trained doctors into the Australian medical workforce

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included. See page 7 of PDF for this item.Linsey S Hart, Jane Vernon-Robert

The impact of generational change and retirement on psychiatry to 2025

<p>Abstract</p> <p>Background</p> <p>Australia is currently experiencing widespread shortages of psychiatrists. The changing nature of the workforce and increasing demand mean that these shortages are unlikely to ease. This study aims to identify demographic change and retirement patterns of the Australian psychiatry workforce from 1995 to 2003, and the implications of those changes for future workforce planning.</p> <p>Methods</p> <p>Data from the Australian Institute of Health and Welfare (AIHW) Medical Labour Force Survey from 1995 to 2003 is used to examine ageing of the psychiatry workforce and attrition of psychiatrists aged 50 years and over. Future attrition from the workforce is projected to 2025.</p> <p>Results</p> <p>Sixty two percent of psychiatrists practicing in the year 2000 are predicted to have retired by 2025. Most psychiatrists continue to work until late in life, with only 18 per cent retiring before age 65. The psychiatry workforce aged significantly between 1995 and 2003 (p < 0.001), with men older than women in both years. A reduction in hours worked by psychiatrists reflects both the increasing proportion of females and the older members of the profession reducing their hours in preparation for retirement.</p> <p>Conclusion</p> <p>The impact of ageing of the workforce may be more immediate for psychiatry than for some other health professions. With the growing proportion of females and their typically lower workforce participation, more than one younger psychiatrist will be required to replace each of the mostly male retirees.</p

The Supply of Doctors in Australia: Is There A Shortage?

understand the situation better, this paper reviews the current English language literature on the supply of doctors in developed and developing countries with a special interest in Australia. The definition of doctor shortage and the accepted ratio of patients to full-time equivalent (FTE) doctors that is followed in this paper, is the one that is provided by the Australian Government�s Department of Health and Ageing. The issue of supply imbalance with respect to doctors is one that is particularly controversial in Australia, with some policy-makers arguing that it is a problem of under-utilisation of existing doctors, not under supply. The paper focuses on the literature on (1) mobility issues relating to geographical and sectoral imbalances, (2) incentive issues (monetary and non-monetary) relating to medical specialisation imbalance and (3) government regulation issues relating to geographical, sectoral and professional specialisation imbalances. The paper offers some suggestions to deal with the problem of supply imbalance. One of the key findings is that developed countries such as Australia cannot continue to rely on foreign-born overseas trained doctors to fill the gaps in supply. Hence, to solve the medical workforce crisis, Australia will have to increase the number of doctors being trained.

APS200 project – the place of science in policy development in the public service

The report aims to achieve better government outcomes through facilitating the effective use of scientific input in policy development in the public service. The Australian Public Service (APS) is increasingly tasked with solving complex policy problems that require significant input from science in order to address them fully and appropriately. Policy making within the APS needs to be based on a rigorous, evidence‐based approach that routinely and systematically draws upon science as a key element. The Australian Government’s investment in science, research and innovation capacity supports a long‐term vision to address national challenges and open up new opportunities. This investment is also significant, with the Commonwealth providing $8.9 billion to support science, research and innovation in 2012‐13. There is an opportunity to harness this investment to address complex societal challenges, by ensuring that scientific research and advice is more effectively incorporated in the development of evidence‐based policy. There is an opportunity for policy makers to make better use of the science capacity provided by our science institutions, including publicly funded research agencies and other science agencies, universities, Cooperative Research Centres and Medical Research Institutes. There is also an opportunity to capitalise on the willingness of scientists to contribute their research results to the policy making process

A model for best practice HTA

The aims of this paper are: to review and describe different approaches to HTA used in Australia and in other countries and to identify the features of best practice in HTA, particularly those likely to be most relevant to HTA at a local (ie state/regional) level. There are a number of well-developed models of HTA at the national and local levels. Most information about the operation of these models, particularly about the type and number of evaluations conducted, the recommendations/decisions made and the reasons for these is available for national processes, but there is much less readily available documentation about local level HTA. Most HTA processes that operate nationally and internationally can be categorised in one of three ways: guidance (provides structured information about appropriate technologies), mandatory (provides mandatory information about technologies to be implemented) and funding and implementation (provides structured evidence-based advice about which technologies should be implemented, the level of funding required to implement them and the source of these funds). The main factors which distinguish a high quality HTA process are that i) it is efficient in terms of setting priorities, the scope of the technologies to be assessed, avoidance of duplication and overall cost of the process, ii) the overall impact on utilisation and health budget is calculated as part of the HTA and iii) procedural justice occurs and is seen to occur; iv) it includes a comprehensive assessment of the impact on issues such as workforce, credentialing of providers and the ethical dimension of the technology; v) it influences decision making by being communicated appropriately and using trusted methods; vi) it influences adoption and diffusion of technology by ensuring that there is no diffusion prior to HTA, the results are incorporated into guidelines or recommendations, funding is linked to the decision, and remuneration arrangements and other characteristics of the HS facilitate the appropriate adoption and diffusion and vii) it influences health outcomes/efficiency/equity by ensuring that the methods and/or results are available and able to be used at a local level. Firm recommendations for an ideal system for HTA at the local level are not possible as much of the necessary information and evidence is not available about the strengths and weaknesses of HTA practices and processes currently in use. However, it is likely that the operation of a successful model of HTA at a local level would require the development of a central organizational unit, a process for implementing the results of HTA and, crucially, the building of capacity to support both types of activities. Additional expertise and skills will be required for both providers of HTA evaluations and for the commissioners and users of HTA.health technology assessment, Australia, review

Should I stay or should I go? Exploring the job preferences of allied health professionals working with people with disability in rural Australia

Introduction: The uneven distribution of allied health professionals (AHPs) in rural and remote Australia and other countries is well documented. In Australia, like elsewhere, service delivery to rural and remote communities is complicated because relatively small numbers of clients are dispersed over large geographic areas. This uneven distribution of AHPs impacts significantly on the provision of services particularly in areas of special need such as mental health, aged care and disability services. Objective: This study aimed to determine the relative importance that AHPs (physiotherapists, occupational therapists, speech pathologists and psychologists – “therapists”) living in a rural area of Australia and working with people with disability, place on different job characteristics and how these may affect their retention. Methods: A cross-sectional survey was conducted using an online questionnaire distributed to AHPs working with people with disability in a rural area of Australia over a 3-month period. Information was sought about various aspects of the AHPs’ current job, and their workforce preferences were explored using a best–worst scaling discrete choice experiment (BWSDCE). Conditional logistic and latent class regression models were used to determine AHPs’ relative preferences for six different job attributes. Results: One hundred ninety-nine AHPs completed the survey; response rate was 51 %. Of those, 165 completed the BWSDCE task. For this group of AHPs, “high autonomy of practice” is the most valued attribute level, followed by “travel BWSDCE arrangements: one or less nights away per month”, “travel arrangements: two or three nights away per month” and “adequate access to professional development”. On the other hand, the least valued attribute levels were “travel arrangements: four or more nights per month”, “limited autonomy of practice” and “minimal access to professional development”. Except for “some job flexibility”, all other attributes had a statistical influence on AHPs’ job preference. Preferences differed according to age, marital status and having dependent children. Conclusions: This study allowed the identification of factors that contribute to AHPs’ employment decisions about staying and working in a rural area. This information can improve job designs in rural areas to increase retention