Action time for roles reform
The launch this week of a new health workforce institute will keep up the pressure for new models of health worker. Health editor Adam Cresswell reports
LABOR’S election victory has dramatically changed the outlook for Australia’s health system. State and federal bureaucracies, profession organisations and pressure groups landscape are suddenly electrified by the need to develop or monitor proposals for implementing the new Government’s plans — ranging from reducing waiting lists, improving preventive care, devoting more resources to hard-pressed GPs and fixing the lack of access to medical services in the bush.
Underneath these headline-grabbing issues, a raft of other currents are flowing. One of them concerns the health workforce, which is creaking at the seams, and will continue to do so for many years because the length of training means that recent increases in university training places will in some cases not flow through to more doctors, nurses and others until 2015 at the earliest.
Last year the Liberal Government disappointed advocates for reform by shelving radical Productivity Commission proposals to create new types of health worker, allow nurses and others to perform tasks currently the exclusive domain of doctors, and adjust training programs to produce health workers suited to more specific roles.
But the change of government has raised hopes that some of these proposals may get another airing in the corridors of power. A new think-tank and research institute announced this week aims to ensure these ideas are voiced with sufficient decibels for ministers sit up and take notice.
The Australian Health Workforce Institute, announced this week as a joint initiative of the Universities of Melbourne and Queensland, is openly espousing many of the ideas backed in the Productivity Commission report, including the expansion of new types of health worker — such as US-style physician assistants.
It also backs extending the roles of existing workers such as nurses and allied health workers, such as physiotherapists; allowing them to work more efficiently through better use of information technology such as shared records and better use of preventive care, already a declared priority for the federal Government.
The AHIW also aims to conduct research to find out what shortages exist in various health and medical disciplines, and whether these are likely to improve or worsen over coming years. As the Productivity Commission report last year noted, estimating even current shortages is not straightforward; projecting future needs is even more precarious.
The Government’s official suppliers of workforce data regarding doctors, the Australian Medical Workforce Advisory Committee, knows this only too well. Although in the election campaign the Liberal Government took flak for having misjudged the medical workforce needs in the 1990s, when training places were cut, the previous Labor Govern- ment took a similar approach. The policies were backed by data provided by AMWAC, which — to the consternation of the medical profession — insisted there was an oversupply, particularly of GPs.
‘‘ We need to have something that’s independent (to compile workforce data) — something that’s going to ensure that the workforce numbers are collected correctly,’’ says Peter Brooks, executive dean of the University of Queensland’s faculty of health sciences and interim director of the new institute.
A long-standing advocate of health workforce reform, Brooks says that as bad as it already is, the existing shortage of doctors and nurses worldwide is just going to get worse — and that AHWI will be much more activist than AMWAC, in that the new institute will also conduct research and advocate for specific proposals.
‘‘ AMWAC, you would have to say, has been there for a while, and was there when we were told we had too many doctors in this country,’’ Brooks says. ‘‘ AMWAC is not going to do too much research — it’s going to collect the data but it’s not really going to query the data. If the ophthalmologists say ‘ we need another 1000 ophthalmologists’, we really need someone to ask how many we would need if we created physician assistants, or if we found a new way to cure cataracts.
‘‘ AMWAC is not going to do what this institute will do, which is look at the health system — look at the sort of health system we will have in 2020.’’
It’s probably not unfair to speculate that AMWAC’s numbers ended up being wildly out because it failed to spot, or at least give adequate weight to, emerging demographic factors. These include the increasing feminisation of the workforce (as women tend to work shorter hours than men, and go on maternity leave), fewer hours being worked by men, the ageing of the medical workforce, increasing sub-specialisation and a trend for qualified professionals not to practise.
But as its name implies, the AHWI will be looking at the entire health workforce, not just doctors, and many of the above points apply to nurses as well. The nursing workforce is also straining, and faces a demographic time-bomb because so many nurses are 10-15 years away from retirement.
Many thousands are also no longer working as nurses.
Brooks is candid about the AHIW’s interest in developing new models of health worker, and that it will ‘‘ pick up a number of issues that were raised by the Productivity Commission’’. ‘‘ My view is that the Productivity Commission report was actually a very good Continued inside — Page 13
Role players: Professor Peter Brooks with students, from left, Andrea Diaz (nursing), Ali Alshami (physiotherapy) and Michael Bonning, Australian Medical Students Association president