GPs short­age a long-term worry

Con­cerns are grow­ing that med­i­cal work­force plan­ning is be­ing ne­glected. Health ed­i­tor Adam Cress­well re­ports

The Weekend Australian - Travel - - Health -

THE pre­vi­ous gov­ern­ment prob­a­bly copped an un­fair share of the blame for Aus­tralia’s doc­tor short­age. Al­though its own poli­cies of cut­ting back on train­ing places un­doubt­edly made this prob­lem worse than it would oth­er­wise have been, those poli­cies were rooted in be­liefs shared on both sides of pol­i­tics in the 1990s that the coun­try was awash with doc­tors who were busy drum­ming up busi­ness to keep them­selves in BMWs.

Had it be­gun sooner its poli­cies of turn­ing this around by in­creas­ing med­i­cal school places — and had it shouted about it a bit louder — the Coali­tion might also have ben­e­fited from the re­verse ef­fect, the il­lu­sion that the prob­lem had been fixed and would be solved in due course.

But con­cerns are be­ing raised that — con­trary to pop­u­lar be­lief — the dra­matic in­creases in Aus­tralia’s med­i­cal school out­put, which will start flow­ing through the sys­tem from 2012, will still leave big prob­lems in the med­i­cal work­force with­out ex­tra steps to en­sure grad­u­ates go where they are most needed. In par­tic­u­lar, the Na­tional Rural Health Al­liance says that al­though the num­ber of grad­u­ates will rise from 1350 per year to nearly 2500, there is lit­tle cause for re­as­sur­ance that the tra­di­tional ar­eas of short­gage — both in terms of med­i­cal dis­ci­pline, and ge­o­graph­i­cal lo­ca­tion — will get the re­lief they need.

In ge­o­graph­i­cal terms, the ar­eas of need re­main (un­sur­pris­ingly) most rural ar­eas, while the med­i­cal dis­ci­plines that have been feel­ing the pinch in­clude gen­eral prac­tice, men­tal health and pathol­ogy.

‘‘ At the mo­ment doc­tors come out of univer­sity and do ba­sic train­ing, and then they head off to what­ever spe­cialty or re­gion at­tracts them the most,’’ an Al­liance spokesman said. ‘‘ There’s no guar­an­tee that the dis­tri­bu­tion that you get, ge­o­graph­i­cally and across the spe­cial­ties, will re­flect the health needs. There’s cer­tainly an as­sump­tion that if we train more grad­u­ates, our short­ages will be taken care of.

‘‘ We are chal­leng­ing that as­sump­tion — we know, for ex­am­ple, that not enough peo­ple are go­ing into gen­eral prac­tice.’’

In 2005 the Aus­tralian Med­i­cal Work­force Ad­vi­sory Com­mit­tee (AMWAC) es­ti­mated that about 1100 new GPs were re­quired each year — a con­sid­er­able in­crease on the cur­rent cap of 600 places an­nu­ally.

The Howard Gov­ern­ment made a pre­elec­tion prom­ise to in­crease this al­lo­ca­tion in stages — to 700 next year, 800 in 2010 and 900 in 2011 — but the La­bor Gov­ern­ment has as yet made no com­mit­ment to adopt this pol­icy it­self.

GP lead­ers are un­der­stood to be hop­ing that there will be an an­nounce­ment in the bud­get, to be handed down on May 13, that the gov­ern­ment will in­crease GP train­ing places.

But the prob­lem is not just about num­bers: it’s also about the choices that med­i­cal grad­u­ates make, and the in­cen­tives in place that in­flu­ence their de­ci­sions.

The NRHA ar­gues that the in­cen­tives cur­rently just aren’t work­ing to tempt peo­ple into ar­eas where they are most needed, as wit­nessed by the fact that the GP train­ing pro­gram’s cur­rent ceil­ing of 600 places was un­der­sub­scribed for years and only had to turn good can­di­dates away for the first time last year.

Af­ter their train­ing is com­pleted, too few are then choos­ing to go to work in the coun­try.

‘‘ With­out over­seas-trained doc­tors the (rural) sit­u­a­tion would be dire,’’ the NRHA spokesman says.

‘‘ We are sug­gest­ing that the in­creased num­ber of grad­u­ates will not nec­es­sar­ily guar­an­tee that you get the right spread, ei­ther ge­o­graph­i­cally or across the pro­fes­sions.

‘‘ What we are say­ing is there needs to be an in­cen­tive frame­work . . . We are not be­ing too pre­scrip­tive. We have floated a few ideas, such as quo­tas and bonded schol­ar­ships.’’

Other or­gan­i­sa­tions have held sim­i­lar con­cerns for some time. The Royal Col­lege of Pathol­o­gists of Aus­trala­sia has protested re­peat­edly at the fail­ure of state gov­ern­ments to fund suf­fi­cient train­ing places in its spe­cialty, which re­main stub­bornly be­low AMWAC-rec­om­mended lev­els.

Some of the more hyped meth­ods of work­ing around rural staffing short­ages have also been shown to have prob­lems of their own. Telemedicine has fre­quently been spo­ken of as a po­ten­tial so­lu­tion to lack of ac­cess, since it po­ten­tially al­lows a pa­tient to con­sult a doc­tor via au­dio or video link when they may be hun­dreds or thou­sands of kilo­me­tres apart. How­ever, an AMWAC re­port on the GP work­force is­sued in 2005 re­vealed one dis­as­trous at­tempt to treat a pa­tient with men­tal health prob­lems by us­ing telemedicine to put her in touch with a men­tal health spe­cial­ist in a cap­i­tal city.

‘‘( The health pro­fes­sional) spoke of an at­tempt to pro­vide spe­cial­ist sup­port to some pa­tients by telemedicine, in­volv­ing a pa­tient re­ceiv­ing ad­vice from a psy­chi­a­trist via a TV mon­i­tor,’’ the re­port said. ‘‘ This . . . merely re­in­forced the pa­tient’s prior con­cerns that ‘ the TV is talk­ing to me’.’’

Mean­while, the NRHA be­lieves the de­ci­sion by the Coun­cil of Aus­tralian Gov­ern­ments to scrap AMWAC and re­place it with a new body has the po­ten­tial to re­duce trans­parency and cred­i­bil­ity of health work­force data.

The re­place­ment body, Health Work­force Aus­tralia, has a Na­tional Health Work­force Task­force that be­came op­er­a­tional ear­lier this year. It has started a pro­gram of work, in­clud­ing pro­ject­ing the sup­ply and de­mand for health work­ers both at a macro level — in­clud­ing doc­tors, nurses, and al­lied health work­ers such as po­di­a­trists, den­tists and phys­io­ther­a­pists — and also sub­se­quently the sup­ply and de­mand for spe­cific health spe­cial­ties in­clud­ing emer­gency physi­cians and anaes­thetists.

The NRHA be­lieves that the new struc­ture may be less trans­par­ent and says it re­mains un­clear whether re­ports and find­ings by the new body — and the method­ol­ogy used to cre­ate them — will be made pub­lic to the same de­gree as was the case un­der AMWAC.

Doc­tors on the way: But there is ev­i­dence that even so, the num­ber of med­i­cal stu­dents who choose gen­eral prac­tice will still not keep up with de­mand

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