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The future of the health workforce

It’s a brave person who forecasts the future.  In the hierarchy of those predicting our future it is the weather forecasters who are the one-eyed kings in the land of the blind.  Some way behind come economists then stockbrokers, racing tipsters and perhaps bringing up the rear are those who try to predict the demand and supply for health workers, including doctors.

18 Sep 2011

By AMA Vice President Prof Geoff Dobb

It’s a brave person who forecasts the future.  In the hierarchy of those predicting our future it is the weather forecasters who are the one-eyed kings in the land of the blind.  Some way behind come economists then stockbrokers, racing tipsters and perhaps bringing up the rear are those who try to predict the demand and supply for health workers, including doctors.

Predicting future workforce needs even five years from now has many variables to put into the equation.

On the supply side are graduates, participations rates, retirements, retention, resignations, and distribution geographically and by specialisation or skill-mix.

On the demand side are the effects of population ageing, increases in population, the effect of increased efficiencies and new technologies, and changing expectations of the health system in relation to access, waiting times, and so on.  Add to this the jokers of the ‘unknown unknowns’ and Australia’s ability to meet the cost of underlying demand for healthcare and it’s no wonder that workforce modelling is so hard to get right.

Nevertheless, Health Workforce Australia (HWA) is giving this task a really big shake - not just for the next few years, but through the workforce pipeline to 2025.  While ambitious, it’s realistic because those entering our medical schools next year will at best be in the early years of their specialist practice by 2025, whether that is as general practitioners, physicians, surgeons, or any other field of practice.

The current work of HWA is still under wraps but should be in the public arena by the end of the year.  The AMA has had significant input, and it is pleasing to see that the somewhat daunting work before them - that currently extends not just across the whole of medicine, but includes nursing and midwifery - is being tackled with a promising level of sophistication.

We are assured that workforce estimates will include sensitivity analysis and the underlying assumptions will be explicit and public so changes, over time, can be plugged into the models to assess their effect.  The overall aim expressed by Health Ministers is that Australia should aim for self-sufficiency in health workforce by 2025.

On the periphery of this work are potential wreckers of responsible workforce planning.  For medicine, these include the potential for unfettered expansion of domestic full fee paying places in MD programs.  While some argue for unregulated competition for medical student admissions, the reality is that our capacity to provide quality clinical placements is finite, and already stretched.  Matching the flow of medical students into the system to teaching and training capacity at undergraduate, pre-vocational, and vocational levels will be a key to the success of future planning.

An important component of capacity building should be a careful exploration of Australia’s medical academic workforce.  Anecdotal evidence suggests problems with recruitment and university funding constraints have limited the expansion that should have reflected the increase in medical graduates.

The expectations on medical academics are high for leadership in clinical excellence, teaching, research, and departmental management.

But while an academic career can have its own rewards, there is a strong case that they are undervalued in terms of remuneration, and this may be one of the impediments to developing this vital foundation for medical teaching and training.

The other major input to our medical workforce is immigration.  More countries are graduating more medical graduates than they need or can afford to pay.  Training standards vary widely, justifying the examination process of the Australian Medical Council.

Nevertheless, medical immigration has approximated our own graduates in some years, making a major and much needed contribution to Australia’s medical workforce and especially in regional, rural and remote areas, and plugging the gaps in resident and registrar positions.

Managing the reduction in medical immigration as Australia moves to self-sufficiency will be a further challenge, but must be done in a way that does not disadvantage those who have helped the nation through a period of workforce deficiency.

Just as challenging will be matching career preferences and community needs. Getting the right balance between specialisation and generalism is likely to need careful timing of the incentives behind career choices to get it right.

So, the journey of medical workforce planning has started with some good first steps and constructive consultation with the AMA - but it’s a journey with a long way to go.  Getting it right will be of vital interest to every medical practitioner.  It is one of the AMA’s top priorities to keep it all on track.


Published: 18 Sep 2011