THE FUTURE HEALTH WORKFORCE: OPTIONS WE DO & DO NOT HAVE Robert Wells

BIG PICTURE  Environmental change  Globalisation  Trade agreements  Free markets: competition policy; small government  Balanced budgets  Health costs ‘out of control’  ‘Intergenerational’- increased ‘dependency’  Urbanisation  Centralisation of policy within governments

WORKFORCE IMPERATIVES  Workforce shortages in all health professions  Measures such as rural bonded scholars will alleviate for a while only  Over reliance on temporary foreign workers is risky  Declining local school leavers over next decade  Reduced workforce participation by both males & females  Cannot fill all our GP training places  Difficulties retaining nurses

CURRENT HEALTH CARE MODELS  Doctor intensive  Strong professional demarcations: little flexibility  Increasing specialisation  Medicare $ demand-driven rather than strategically applied to need  Basically a ‘one size fits all’ model  Rural operates as a ‘pale reflection’ of urban models

ANALYSIS  Current models of service delivery & funding for rural communities are unsustainable  Therefore need to explore alternative approaches  Cannot focus just on workforce  Need to begin that process now before it is too late

CHANGE THE SYSTEM  New models of care- evidence based  New approaches to workforce  New funding & remuneration models  One level of government

NEW MODELS OF CARE  A decade of research, trials & pilots  Many innovative models to be evaluated  Synthesising & evaluating this material in a systematic & policy focussed way a first step in setting a rural health research agenda

NEW APPROACHES TO WORKFORCE  Multidisciplinary teams  Nurse practitioners & physician assistants  Need for reforms to education & training  Expand the education, training and research infrastructure provided through rural clinical schools & university departments of rural health

NEW FUNDING & REMUNERATION MODELS  Time to review fee for service from care and workforce perspectives  Would per capita funding better suit needs of rural areas?  More flexibility in budgets & accountability for rural health authorities  Public investment in infrastructure

ONE LEVEL OF GOVERNMENT  Problems in funding divide especially problematic in rural areas where there are fewer resources to go around  Could one level of government take total responsibility for rural health care?

CONCLUSION  Rural health crisis likely to get worse on current trends  Need innovative solutions at several levels: care models; workforce & infrastructure; funding & remuneration; government ‘ownership’