Australian Medical Workforce Advisory Committee Research Articles

Guest Editorial: Getting Evidence into Policy - Stimulating Debate and Building the Evidence Base

In this special edition of the Journal, we have brought together papers with the aim of contributing to primary health care reform in Australia. The papers will stimulate further debate and increase the evidence base through which policies can be informed. Does primary health care in Australia need reform? Are there fundamental problems with the health system demanding a reform response? The challenges confronting Australia's health care system over the next decade are real and well documented (Productivity Commission, 2005; Australian Medical Workforce Advisory Committee [AMWAC], 2005). They include the ageing population and longer life expectancies, the increasing prevalence of chronic illness and co-morbidity, heightened consumer expectations, advances in health technologies and shortages in the health workforce.

Factors influencing decisions about the state in which doctors plan to practise: additional results from the 2002 Australian Medical Workforce Advisory Committee national survey

As a result of growing doctor shortages, postgraduate doctor recruitment and retention within Australian states and territories has become an issue of concern. Australia's policy of national self-sufficiency in health workforce supply implies that state medical schools will, at a minimum, enroll a sufficient number of locally born students to meet future medical workforce requirements. This article focuses on factors influencing the state or territory in which doctors plan to practise medicine, identified through a national survey. Independent variables of interest were birth place, medical school and vocational training location because of their importance to medical workforce policy. The study found that the career location plans of Australian-born and overseas-born doctors in vocational training were similar and that 5% of doctors planned to work overseas. Of Australian-born doctors who planned to work in Australia, 88% graduated from a medical school in the state in which they were born, while 78% and 65%, respectively, were undertaking vocational training in, and proposed to work in, the state in which they were born. The study concludes that trainee-doctor decisions about the state or territory in which they will practise medicine when they are fully qualified are more complex than location of birth.

Editorial

In last year's editorial, Professor Ian Wronski, then President of ACRRM, set out the criteria on which we were asserting the speciality status of Rural and Remote Medicine. This was based on the work of Professor Roger Strasser,1 developing on the work of McWhinney, who identified four determining criteria of whether an area of academic endeavour constitutes a distinct discipline Formation of a dedicated academic body by a reasonable number of its practitioners; An intellectually rigorous training program; Emergence of a body of disciplinary literature by the its practitioners, and; Recognition outside the discipline, especially by other disciplines, universities and society (i.e. government). What has happened since then? The College remains and grows stronger with over 1700 members and many other students and doctors associated with programs. Our training program is now recognised by General Practice Education and Training (GPET) and is incorporated in its contract with Government. We have developed significant and innovative programs in obstetric and emergency ultrasound, radiology, dermatology and population health, to mention but a few. Rigorous criteria for fellowship that acknowledge the diversity of paths to Rural and Remote Medicine and recognise training and experience have been developed. Our examination process is being finalised. The disciplinary literature is becoming exponentially stronger. Only this year the Handbook of Rural Medicine has been published and other publications join the groundbreaking work of the Australian Journal of Rural Health.2 Universities and regional training providers have increasingly embraced the discipline with innovative programs. Rural Medical school training models building on the groundbreaking work of Professor Paul Worley have spread rapidly across the rural landscape with repeated reports of these young doctors-to-be requesting to stay on for an extra year or staying for their residency. Australian universities have appointed the worlds first chairs of rural medicine. On 16 April 2004, ACRRM submitted its application to the Australian Medical School for recognition of Rural and Remote Medicine as a speciality. It contains 93 pages of tightly crafted argument with 242 core references to our discipline. The argument is simple – like many disciplines, ours is dictated very much by context. Emergency medicine exists because of emergency rooms, obstetrics because of childbirth and rural medicine because of rurality. These contextual characteristics of rurality determine many aspects of our discipline. The isolation calls for a different form of risk management that selects for the better of two difficult options – to keep and treat or to send. The characteristics of rural illness present special challenges from melioidosis to leptospirosis, from farm accidents to high speed motor vehicle accidents on lonely roads. Our large indigenous populations demand special attention and skills. Our patient's stoic attitude can often result in late presentation and advanced disease. Rural doctors provide much needed skills outside the normal bounds of medicine, acting as advocate and conciliator, friend and counsellor, public health adviser and individual health trainer. In this milieu, although the presenting complaint may be often essentially the same the rural practitioner needs a deeper range of skill across many areas to fulfil their duties to the patient and their community.3 There is not the discretionary option of treat or refer, but a real need to provide a wide range of services locally. The Rural Doctors Association Viable Models report demonstrated that both in the office and hospital, rural doctors had to take a greater responsibility.4 This is not just the ability to work in unsupervised practice, but to work in a practice without the comfort of a range of specialists close at hand. This is self supporting network of generalists each with there own broad range of skills. This is the only way that rural areas can obtain high quality care. As the Australian Medical Workforce Advisory Committee (AMWAC) acknowledged in 2000: In small rural centres, other rural areas and remote areas, the majority of day-to-day medical care in the hospital and non-hospital setting is provided by GPs. This includes primary care, in-patient care and most procedural care (obstetrics, anaesthetics, operative obstetrics, general surgery, trauma, medical emergency and other matters such as endoscopy and radiology). These GPs are also likely to be providing non-clinical medical services, including in public and population health, administration including hospital administration, and activities associated with running Divisions of General Practice. There is also a wider expectation on the individual doctor by the community to act as health advocate and more generally take a leadership role in the community.5 The only point of difference that I would have with AMWAC on this is that these are not GPs – these are specialists in Rural and Remote Medicine.

2002 Australian radiology workforce report.

This paper describes the current status of radiologist provision in Australia, and explores issues relating to its current adequacy, as well as analysing projections of supply and requirements, and their balancing. Data are drawn from several sources including the results of the Royal Australian and New Zealand College of Radiologists Workforce Survey 2000, and the report of the Australian Medical Workforce Advisory Committee Radiology Working Party 2001. The main conclusions to be drawn are that: (i) there is a current shortfall of radiologist supply in Australia; (ii) future requirements (taking all factors into consideration) are expected to grow at a greater rate than projected supply (based on the status quo); and (iii) supply of radiologists should therefore be increased. These conclusions are roughly in line with those from other countries, such as the UK, Canada and USA. Radiologists practising in Australia also appear to have relatively high productivity, including by some international comparisons. These findings are presented in the context of current issues in Australian medical imaging, including provider consolidation and corporatization, globalization and funding.

The cardiothoracic surgery workforce in Australia: Supply and requirements 2000–2011 report of the Australian medical workforce advisory committee 2001

To establish a national profile of the current cardiothoracic surgery workforce and advise the Australian Government on workforce requirements to 2011, the Cardiothoracic Surgery Workforce Working Party brought down a report in May 2001 to The Australian Medical Workforce Advisory Committee. The survey data were taken from half the current Fellows of the Royal Australian College of Surgeons engaged in cardiothoracic surgery. Australian cardiothoracic surgeons are typically middle-aged males working more than 60 h per week. Their work has both private and public sector components and most surgeons provide services in both cardiac and thoracic surgery to an average catchment of 180 000 people. Concentrated in the capital cities, mainly on the eastern seaboard, they devote 90% of their working hours to service delivery, with little time spent in research and developmental aspects of their profession, or in administrative roles. The committee provided 10-year projections for surgical services, predicting an annual growth in service requirements of 1.8% in Australia to 2011. The report concludes that maintenance of the present intake of surgical trainees at five per year — offset by the projected retirements of 2.7 surgeons annually — will be sufficient to meet demand. This conclusion is based on an assumption of a decade of unchanged national health structures and patterns of workforce participation and service delivery.

Projected requirements for radiation oncologists and trainees in Australia and New Zealand to 2007

Workloads in radiation oncology facilities in Australia and New Zealand have been increasing steadily for many years and it is anticipated that this trend will continue. In the present paper the projected number of radiation oncologists required to meet this demand to the year 2007 are estimated, along with the number of trainees required. The estimates are based on data from regular surveys by the Royal Australian and New Zealand College of Radiologists (RANZCR) for the years 1988-97 (inclusive). From these surveys profiles of numbers, age and gender of specialists and trainees are documented together with increases from the training programme and losses from retirement. It is concluded that if the current trainee numbers are increased by 12 in Australia and two in New Zealand, there will be approximately 10 radiation oncologists per million of population by the year 2007. This number is considered appropriate considering the anticipated increase in demands and complexity of treatment. Because projections too far forward are unreliable, careful monitoring of progress is essential to obtain the appropriate balance between requirement and supply. Comparisons are made with other estimates of needs including the 1998 Australian Medical Workforce Advisory Committee (AMWAC) Report and the New Zealand Clinical Agency Workforce Project Report in 1997.

Medical workforce planning in Australia

The Australian Medical Workforce Advisory Committee (AMWAC) was established by the Australian Health Ministers' Advisory Council (AHMAC) in 1995 to provide information and analysis to AHMAC and the profession about the medical workforce to inform the policy process. This article provides a brief history of the events leading to the formation of AMWAC and of the work of this committee, particularly its approach to medical workforce planning and the outcomes of some of its research. The paper concludes that the forces leading to and maintaining workforce geographic and structural maldistribution are better understood as a result of AMWAC studies and the work of other stakeholders. Further research is required to improve understanding of the hospital medical workforce and the factors influencing the career decisions of young doctors and to monitor the impact of strategies to improve workforce distribution.

The Australian medical workforce advisory committee — Review of the psychiatric workforce

The Australian medical workforce advisory committee — Review of the psychiatric workforce

Toward gender balance in the Australian medical workforce:some planning implications

Men and women doctors participate differently in the workforce. As the proportion of women in the workforce increases, gender-based differences in workforce participation are raising important planning questions. For example, how will differences in hours worked per week impact on the number of trainee doctors required to meet future demand, why do some disciplines attract more women, what will be the impact on the practice of medicine if these trends continue and how does the training environment impact on variation in career decision. In this paper we summarise and discuss the findings of recent research undertaken by the Australian Medical Workforce Advisory Committee and outline some public policy responses.

Australian Medical Workforce Advisory Committee (AMWAC) Working Party to Review Psychiatry Workforce

As part of its 1998/99 work plan the Australian Medical Workforce Advisory Committee (AMWAC) has been asked to provide advice to the Australian Health Ministers' Advisory Council (AHMAC) on the characteristics, distribution and adequacy of the current psychiatry workforce. In addition, the working party has been asked to recommend strategies for the promotion of an adequate supply and appropriate distribution of psychiatrists for the next decade. It is anticipated that the working party will provide a final report to the first meeting of AMWAC in 1999, probably around March or April.

Methodology for the study and projection of surgical and anaesthetic workforce.

The Australian Medical Workforce Advisory Committee has studied the specialties of anaesthesia, general surgery, orthopaedics, ophthalmology and urology in Australia. A methodology is presented for rationalizing various data sources to establish numbers and characteristics of the existing workforce, for applying a variety of information to establish opinion about current adequacy, to project future needs and to advise the mechanisms to ensure delivery of services. This study emphasizes the importance of the cooperative input of governments, health administrations and professional bodies, careful gathering of fundamental data, the studied application of uneven pieces of evidence, recognition of changes in needs and demands, the overlap of sectors of the medical workforce in service delivery, and the requirement for continued study and monitoring. The current size of the workforce in these surgical specialties is found to be satisfactory overall but with some uneven distribution. The anaesthetic workforce is found to be slightly deficient in number overall. The growth of future demand for these specialties was estimated between 1% and 3% per annum and requirements for increases in trainee numbers to meet these projected future demands are defined.

Specialist adult physicians in the Top End of the Northern Territory:An analysis of their number and roles

The optimal way of delivering specialist services to rural and remote Australia, and particularly to remote Aboriginal and Torres Strait Islander communities, is a matter of keen debate at present, and is being considered by the Australian Medical Workforce Advisory Committee. This paper contributes to that debate by considering one specialist medical group, namely adult physicians, and discusses both their role and optimal number in the Top End of the Northern Territory, in light of the general workforce literature and recent changes to the organisation of physician services in the Northern Territory. Models of specialist service delivery need to be explicit, and organisational methods transparent, if the service is to be equitable, flexible and accountable to primary care practitioners.