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 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  : 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)