1. 1 Building and Sustaining an Appropriate Workforce Professor David A Watters RACS President 26 th October 2015

2. 2 Building and sustaining an appropriate workforce ●What is the situation today? ●What do we want to achieve? ●How are we going to achieve it? ●What is appropriate? ●How will we sustain the workforce? Photo: Katherine Edyvane

3. 3 Proportion of population without access to surgery

4. 4 An Appropriate Workforce Must Deliver ●Capability and Capacity ●Safety ●Affordability ●Timeliness 64% 40% 58% Three Bellwether Procedures

5. 5 Min 20 Surgery, Anaesthesia Obstetric Providers by 2030

6. 6 PNG - Anaesthesia Obstetric Providers by 2030 ●Population – 8m ●Surgeons (93 + 25) ■ 70 surgeons alive and working ■ 12 ENT, 11 Eye, 2 OMS ●Anaesthesia ■ 25 Anaesthesiologists ■ 20-25 Nurse anaesthetists (ATO’s) ●Obstetricians: ■ 30 Diplomates ■ 40 - MMed Specialists PNG = 2.5-3.0 per 100,000

7. 7 Surgical Workforce in ANZ AustraliaNew Zealand Poopulation23.1m4.3m Registered Surgical Practitioners 5570 (4963)859 (771) Registered Anaesthetists 4627 (4163)759 ( 624) Registered O & G1871 (1678)289 (267) Total trained SAO’s 12068 (10804)1907 (1662) SAO’s / 100,000 52.2 (46.7)44.3 (38.6)

8. 8 Perioperative Mortality - Australia 2009/102010/112011/122012/13 Australian Population* 22,031,75022,340,02422,728,25423,129,299 Separations following surgical procedure 902,582921,072944,308952,993 Procedures per 100,000 4096.74123.04154.84120.3 Surgical mortalities 3,8023,6183,4753,395 POMR (%) 0.4210.3930.3680.356 Perioperative Mortality is death before discharge from Hospital Number of patients who died after an admission episode (including day surgery) involving a procedure in an OR

9. 9 Training models for the SAO workforce

10. 10 The apprenticeship model – time based training Time in Training plus a high stakes exit examination

11. 11 COMPETENCIES Developed 2001, Trademarked 2005, Revised 2015

12. 12 9 competencies ■ Medical Expertise ■ Clinical Decision Making ■ Technical Expertise ■ Professionalism & Ethics ■ Health Advocacy ■ Communication ■ Collaboration & Teamwork ■ Management & Leadership ■ Scholar and Teacher RACS Competency Framework

13. 13 Competency Based Training Multiple Workplace based Assessments – formative Summative Assessments of Some Competencies - Decision Making and Clinical Expertise NoviceIntermediate? Competent

14. 14 Is it Fit for Purpose? Agree Standards Measure & Report Progress

15. 15 Training other health workers ●Extending scope of practice ●Nurse anaesthetists – support anaesthetic and surgical care in many countries of this region ●Clinical officers in Sub-Saharan Africa are trained to do surgical procedures ●Medical Officers trained to do Caesarean Sections and other procedures ●Training doctors and others for rural or remote practice

16. 16 Six Principles for Extended Scope of Practice Phil Carson & RACS 2015

17. 17 Brain Drain – The Push and Pull Factors

18. 18 Brain Drain – Your country needs you? But do they make you feel it and look after you?

19. 19 3R’s for Sustaining the Workforce ●Renewal : Engaging them in life-long learning as a principle of practice ●Recognition – career opportunities and recognition within the health system ●Reward – A salary structure that rewards the healthworkforce

20. 20 Universal access to safe, affordable surgical & anesthesia care when needed