Health Workforce

Despite the fact that the health workforce has grown over time, demand for health workers continues to outstrip supply. Factors such as the ageing of the population and the rise in chronic disease have led to an increased demand for the services of health professionals. Ensuring there is an adequate health workforce to meet the needs of the population is therefore likely to be an ongoing issue for the Parliament.

Until the mid-1990s, it was thought that Australia had a sufficient number of doctors for its population. Consequently, restrictions were placed on medical school intakes. By the end of the 1990s, however, doctor shortages in rural and remote areas of Australia had become increasingly noticeable. Initially, it was considered that these were the result of mal-distribution of the medical workforce between the bush and metropolitan areas.

Legislation and initiatives intended to address this perceived mal-distribution were introduced in 1996. These included requiring overseas-trained doctors who wished to access Medicare, to work in areas identified as suffering from doctor shortages.

Despite these initiatives, shortages of doctors persisted in rural and remote areas. Moreover, evidence emerged that there were insufficient numbers of doctors in the outer metropolitan areas of the capital cities. In 2002–03, further strategies were put in place to attempt to address these shortages.

From 2003, a longer-term solution to medical workforce shortages was initiated in the form of continuing increases in the number of medical student places. As a result of these increases, it has been predicted that the number of domestic graduates from Australian medical schools will increase by 81 per cent by 2012.

Medical workforce planning will need to manage the flow-on effects of the policy to increase medical student numbers. Initially, this will involve balancing undergraduate student numbers with adequate training places. It will also involve strategies to ensure that there are sufficient numbers of clinical teachers, that allocation of teaching time and access to patients is adequate, and that necessary infrastructure to accommodate increased numbers of trainees and doctors is in place.

Medical workforce planning will also need to involve strategies to influence the career choices of doctors so that population health requirements are reflected in the composition of the future medical workforce.

By 2003, shortages in the nursing workforce were apparent in metropolitan and regional areas in all states and territories. In response, from July 2004, student nursing places and funding for higher-education providers for nursing courses have increased. However, there are still too few nurses to meet the future health needs of the Australian community. It is estimated that an additional 3000 nursing undergraduate places need to be funded initially to address this shortfall.

In addition to increasing the actual numbers of nurses, strategies need to be implemented to make nursing a more attractive career. These include increasing the status of nursing, redefining nursing responsibilities in both the primary and acute care practice environment, and addressing issues relating to appropriate remuneration.

The 2004 National Health Workforce Strategic Framework highlighted a national shortage of health professionals in many allied health professions, including physiotherapy and pharmacy.

There has been little workforce planning undertaken to understand the extent, causes and impact of allied workforce shortages. Clearly, factors that affect the medical and nursing workforces also affect allied health workers. The option of increasing this workforce, diversifying its capabilities, and developing complementary practitioners who can alleviate the workloads of doctors and nurses should be explored in more depth. Research into the reasons for shortages and possible incentives to enhance career paths should be a priority.

Indeed, it is crucial that priority is given to opportunities to develop appropriate delegation and task substitution models, and enhanced or different scopes of practice for the health workforce. Changing demographics and health needs will not only present the circumstances for such rethinking to occur, but make change imperative if the future health workforces are to meet the health needs of the population.

Documentation
Productivity Commission, Australia’s Health Workforce, Research Report, Productivity Commission, Canberra, December 2005.
Australian Nursing Federation, Providing a nursing workforce for Australians into the future: 2007-08 Australian Government pre budget Submission, 2006.
Health Professions Council of Australia, Solving the crisis in clinical education for Australia’s health professionals, Melbourne, 2004.