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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)