GPs shortage a long-term worry
Concerns are growing that medical workforce planning is being neglected. Health editor Adam Cresswell reports
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