AUSTRALIAN MEDICAL WORKFORCEReforms 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 1990s: 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 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: state & commonwealth; professions; universities, PGMCs 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 care 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’ workforce planning education & training International Medical Graduates practice changes 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 apprenticeships vs. skill centres ‘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 budgeted-includes 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)