AUSTRALIAN MEDICAL WORKFORCE Reforms and challenges Robert Wells, October 2004
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
A DECADE OF REFORM (1) § Early 1990 s: GP reforms, eg ‘VR’; GPET § 1995: AMWAC created § 1996: new arrangements for access to provider numbers
A DECADE OF REFORM (2) § 1996: Medical Training Review Panel § 1997: pre vocational medical councils nationally § 1997: specialist training selection reforms
A DECADE OF REFORM (3) § 1997: reforms to assessment of IMG doctors § 1999: rural education- UDRHs & RCSs § 2000: AMC accreditation of specialist training programs
A DECADE OF REFORM (4) § 2000: Rural Bonded Medical School Places § 2001: Outer Metropolitan medical workforce scheme § 2000 -02: specialist training outside hospitals pilots
A DECADE OF REFORM (5) § 2000: new medical schools JCU, ANU etc… § 2003: ‘Fairer/Plus/Enhanced Medicare’-more medical school places; more IMG doctors; PGY 2/3 doctors rotation scheme § 2004: national medical registration
A DECADE OF REFORM (6) § Workforce planning for nurses & other health professions: AHWAC § Link workforce planning & policy: AHWOC § Nursing reviews § Nurse practitioners
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
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
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
GLOBAL ISSUES/DEMOGRAPHICS § Australia’s competitiveness at risk in a global health workforce market § Long term outlook mixed: declining birth rates- ‘ 2020 problem’
THE CHALLENGE § The system, problems & solutions are complex § Every part of the system needs to be involved in working on solutions: Ø state & commonwealth; Ø professions; Ø universities, PGMCs Ø the public
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 can be delivered away from hospitals § More attention to management of risk factors and prevention of disease
AND SO TO WORKFORCE REFORM § How does workforce reform help deliver the desired health system? § Needs to be comprehensive: no ‘magic bullet’ Ø workforce planning Ø education & training Ø International Medical Graduates Ø practice changes Ø continuing licence to practise
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 Ø apprenticeships vs. skill centres Ø ‘one size fits all’
3 POINT PLAN for TRAINING § Needs major attention § Getting it ‘right’ is basis of continuing excellence of our health system
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
2. SEPARATE TRAINING BUDGET § Training $ separately costed and budgetedincludes salaries for trainees; training costs § Hard to do but worth the effort § Mix of existing & new $
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
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
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)
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