Transcript Document

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
 2000-02: 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)
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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 systemhospital 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)