Reforming Australia’s Medical Workforce: A Decade of Change and Future Challenges

1. AUSTRALIAN MEDICAL WORKFORCE Reforms and challenges Robert Wells,October 2004

2. WORKFORCE REFORM THEMES • Needs of the health system & patients • Workforce planning: supply; distribution; composition • Training from undergraduate to fully qualified specialist • Skills maintenance: ‘licence’ to practise • Assessment of International Medical Graduates

3. A DECADE OF REFORM (1) • Early 1990s: GP reforms, eg ‘VR’; GPET • 1995: AMWAC created • 1996: new arrangements for access to provider numbers

4. A DECADE OF REFORM (2) • 1996: Medical Training Review Panel • 1997: pre vocational medical councils nationally • 1997: specialist training selection reforms

5. A DECADE OF REFORM (3) • 1997: reforms to assessment of IMG doctors • 1999: rural education- UDRHs & RCSs • 2000: AMC accreditation of specialist training programs

6. A DECADE OF REFORM (4) • 2000: Rural Bonded Medical School Places • 2001: Outer Metropolitan medical workforce scheme • 2000-02: specialist training outside hospitals pilots

7. A DECADE OF REFORM (5) • 2000: new medical schools JCU, ANU etc etc… • 2003: ‘Fairer/Plus/Enhanced Medicare’-more medical school places; more IMG doctors; PGY 2/3 doctors rotation scheme • 2004: national medical registration

8. A DECADE OF REFORM (6) • Workforce planning for nurses & other health professions: AHWAC • Link workforce planning & policy: AHWOC • Nursing reviews • Nurse practitioners

9. A DECADE OF REFORM (7) • momentum from ‘AHCAs/ health reform’ processes • Practice nurses in primary care • MBS nurse item • Access to other health professions under Medicare • Safety and quality issues,eg credentialing

10. SYSTEM ISSUES: LACK OF DIRECTION • No national health plan • 8 separate health delivery systems • No agreed national objectives & performance indicators • Separate funding streams within jurisdictional programs at both state & commonwealth levels

11. SYSTEM ISSUES: WORKFORCE • Shortages and maldistribution • Declining hours of work & workforce participation by doctors • Some specialties (eg GP, geriatrics) less attractive for doctors • Poor data on other health workforces, but strong anecdotal evidence of similar problems

12. GLOBAL ISSUES/DEMOGRAPHICS • Australia’s competitiveness at risk in a global health workforce market • Long term outlook mixed: declining birth rates- ‘2020 problem’

13. THE CHALLENGE • The system, problems & solutions are complex • Every part of the system needs to be involved in working on solutions: • state & commonwealth; • professions; • universities, PGMCs • the public

14. FUTURE HEALTH SYSTEMS • Patient-centred: accessible; whole needs • Flexible use of resources including workforce • Safe and effective care: the best care available for the needs of the patient • Technology: more care can be delivered away from hospitals • More attention to management of risk factors and prevention of disease

15. AND SO TO WORKFORCE REFORM • How does workforce reform help deliver the desired health system? • Needs to be comprehensive: no ‘magic bullet’ • workforce planning • education & training • International Medical Graduates • practice changes • continuing licence to practise

16. EDUCATION and TRAINING • Funding is complex and no one has overall responsibility • Takes too long to train a doctor: 10 years + • Results in workforce rigidity-too many professional & specialty demarcations • Training settings are built around a past health system- hospital dependent • Outdated learning methods, eg • apprenticeships vs. skill centres • ‘one size fits all’

17. 3 POINT PLAN for TRAINING • Needs major attention • Getting it ‘right’ is basis of continuing excellence of our health system

18. 1. MAKE SOMEONE ACCOUNTABLE • Federal health minister should be responsible for all health worker training • Supported by a national training authority • Responsible for undergraduate, prevocational, vocational & continuing professional training • Work with and through existing authorities: build on what’s there

19. 2. SEPARATE TRAINING BUDGET • Training $ separately costed and budgeted-includes salaries for trainees; training costs • Hard to do but worth the effort • Mix of existing & new $

20. 3. FOCUS ON THE TRAINING • The prime task is to train tomorrow’s workforce • Training needs to provide the capacity for continuing learning & the skills to work in a changing environment • Cannot overlook the service contribution trainees currently make- but this can be sorted out

21. CAN IT BE DONE? • Prime Minister’s announcement on 22 October • Task Force on health • Look at health policy, in particular Commonwealth/state issues • Possibly change some areas of the interface • Aim is to better align national, state & local

22. CONCLUSION • There is both need and opportunity for continuing training reform • Setting directions will be key • Think outside the box- innovation • National direction: local solutions (one size does not fit all)