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Health workforce planning: the search for a crystal ball continues

Australia’s ignominious history in regards to workforce planning took a step towards recovery last month with the release of Health Workforce 2025 (HW2025). Regular readers of Australian Medicine will be aware that the last edition featured a news article based on the report’s findings. The AMA played an instrumental role in ensuring Health Workforce Australia undertook this critical piece of work, which was commenced in the wake of the 2010 AMA Medical Training Summit.

20 May 2012

Australia’s ignominious history in regards to workforce planning took a step towards recovery last month with the release of Health Workforce 2025 (HW2025). Regular readers of Australian Medicine will be aware that the last edition featured a news article based on the report’s findings. The AMA played an instrumental role in ensuring Health Workforce Australia undertook this critical piece of work, which was commenced in the wake of the 2010 AMA Medical Training Summit.

While other medical publications have also published commentary on the report, references in mainstream media have been relatively limited. Notwithstanding the significant competition for airtime in recent weeks, this is somewhat surprising: the report has major implications for the future delivery of healthcare in Australia.

The headline figures relate to the nursing workforce. Based on complex supply and demand modelling, HW2025 suggests that Australia is facing a shortfall of 109,490 nurses by 2025. This figure is derived from the report’s base-line projection, and blows out considerably under a self-sufficiency scenario.

The figures for the medical profession are nowhere near as staggering. A shortfall of 2,701 doctors is predicted by 2025, which balloons to 15,240 with the application of a “high self-sufficiency” model. Interestingly, under a “low demand” scenario, HW2025 suggests there could be a surplus of doctors to the tune of 18,000.

In terms of the training pipeline, HW2025 predicts a shortfall in first-year vocational training positions (and therefore an excess of applicants) of 404 by 2015 and 1,265 by 2025. This is based on the assumption that current levels of access to medical services are maintained, despite the fact that the community expects improvement. The report also makes projections on the requirements for medical graduates, suggesting that the number of students currently in the system is approximately in balance. More detail on the training pipeline will be available when specialty-specific data is released in Volume Three of the report in June.

The wide variation in the figures generated by the sensitivity analysis illustrates that workforce modelling is an inexact science and producing accurate predictions is exceedingly difficult. Making assumptions, some of which will be proven spurious, is a necessary part of the process.

Invariably, therefore, the methodology of HW2025 will be criticised. Some will dismiss the numbers as mythical, and others will interpret (and/or manipulate) them in a way that suits their requirements. But it remains that it is the best data we have.

So what do the numbers mean? The report, in all its 448-page glory, provides some analysis. It clearly makes the point that workforce reform is essential and Australia cannot afford to tolerate a status quo approach to work practices, productivity, training, geographical distribution and immigration.

In terms of medical education, there are a few immediate implications. For one, the report provides evidence of a looming bottleneck at the point of entry into vocational training. Regardless of whether capacity can expand in line with projected demand, it is likely that competition for registrar posts will increase. More graduates will face the prospect of never gaining a position in their first choice of training program. For these and other reasons, the report provides little ammunition for those angling for new medical schools. It also clearly justifies the AMA’s efforts to focus governments’ attention on the need to fund a significant expansion in pre-vocational and vocational training places.

HW2025 really highlights some much bigger challenges, however. Dealing with a predicted nursing shortfall of 100,000 is a major one, which training alone will not be able to remedy. Although implicit, the costs involved in creating a self-sufficient health workforce have also been made evident, and Australia will need to determine if it is genuinely prepared to address the ‘brain drain’ from developing nations. Further, the predictions that the increasing number of graduates will not itself fix workforce maldistribution means that current approaches to rural recruitment and retention need a rethink.

These challenges are compounded by the stark reality of modern healthcare: that demand, costs and expectations are rising at an unsustainable rate. Although much has been said about the need for rationalisation of health expenditure, this report will undoubtedly stoke the fire.

HW2025 demands a response from the nation’s health ministers, and the challenge now is to ensure a satisfactory one. They have indicated that reform is necessary, but how that agenda will be advanced remains unclear. The AMA is on the record calling for a dedicated Council of Australian Governments meeting to facilitate intergovernmental agreement on the required number of postgraduate training places and beyond.

Irrespective of this process, governments (acting on advice from medical colleges) have their work cut out for them in identifying and funding new training positions. The AMA has already started thinking about how it can report on progress against the growth targets implied by the report.

HW2025 may not be a crystal ball, but at least it has brought the challenges and opportunities sharply into focus. The report offers some useful insights and it should form part of the evidence base for determining future workforce requirements. Importantly, it also provides a lever to encourage meaningful investment in medical training, which is an opportunity that should not be passed up.


Published: 20 May 2012