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20 May 2019

BY AMA VICE PRESIDENT DR CHRIS ZAPPALA, CHAIR OF THE AMA MEDICAL WORKFORCE COMMITTEE

The election is over for another three years. For the new Government, medical workforce management will be one of the defining requirements for ensuring the sustainability of Australia’s health system. Maldistribution and access balanced against oversupply and cost.

Health was a major issue during the election, with all parties proposing significant investment in the areas that they either believed required investment, or hoped would win them votes. Management of Australia’s medical workforce lamentably did not feature significantly – it’s hard to make people interested in something so dry! However, it remains crucial and doctors must shape this discussion – no one else, least of all those who wish to subjugate or control us.

The AMA had a significant win earlier this year with the announcement of the National Medical Workforce Strategy. This is the first strategy of this kind in fifteen years and is a largely a product of years of work by the AMA, culminating in the AMA Medical Workforce Summit held in March last year. The new Strategy will hopefully allow the Commonwealth and the States and Territories to cooperate more closely in planning and coordinating our future medical workforce. It must start therefore as a joint document and not a Commonwealth dictate. Clearly, the 115,000 doctors in this country need to work wisely and ethically together and accept their responsibility in solving our workforce challenges.

The maldistribution of the medical workforce, the vexing issue of workforce oversupply and undersupply in some specialty areas, and the mismatched lack of prevocational and specialist training places for medical graduates once they have left medical school are all issues which the Strategy must address if it is to succeed. But we cannot wait for this Strategy, which is only in the earliest stages of development, before we start to address these issues.

People who know me and read my articles (thank you) will know that I strongly believe we need to actively monitor the number of doctors we are allowing into Australia. We had 3,569 graduates in 2016 (15 per cent of whom were international students). We have the highest medical graduate rate per capita in the OECD and a doctor to patient ratio well above the average and comparable nations. We cannot allow new medical schools. Right now, we are carefully monitoring the situation in Queensland to ensure that no new student places result from the agreement between Central Queensland University and Queensland University. The big business of university education pays no heed to workforce requirement or the enervating effects of oversupply or mismatched/underfunded vocational training. A fortune is made out of nearly a quarter of all medical students who are full-fee paying (most of whom are from overseas) who then add to the ‘lost tribe’ of junior doctors facing significant hardship.

In the same vein, we also need to carefully monitor the immigration of doctors to Australia. Recently introduced visa requirements now mean that a doctor seeking to work in general practice must have the approval of a rural workforce agency first. This is the result of Government regulation and is positive inasmuch as it indicates intention to address workforce issues. However, it is an imperfect solution, and specialties in need that define immigration levels must be revised to ensure that we can recruit specialists when and where they are required without undue bureaucracy.

Moreover, the current definition of a ‘specialty in need’ is curious at best and is potentially exacerbating access to training for domestic doctors and specialties already in or approaching oversupply. We still had 2,730 immigrant doctors on a 457 visa entering in 2016-2017. No one is really monitoring this properly because their vision is so clouded by the maldistribution problem.

For a new government seeking to make their mark, much of the groundwork is already there. For example, there are significant opportunities to expand training in rural and regional areas (MMM 2-4) and support a desperately needed expanded workforce with genuine enticements for doctor and family. Many regional and rural communities have significant need of doctors from all specialties while also having the capacity to support more training. There are innumerable practice and by extension training opportunities in regional areas that are yet to be tapped and simply must be if we are to solve our workforce problems.

Earlier this year, the AMA conducted the 2019 Rural Health Issues. The survey asked doctors practising in regional, rural and remote Australia to rank their priority issues for improving rural health. Unsurprisingly, the results were very similar to the 2016 Survey. Despite this, the doctors were overwhelmingly positive about their experiences in their communities.

Many doctors also expressed frustration at the assumptions urban doctors make regarding the infrastructure and facilities available at their local hospitals. Too often, doctors reported that their metro colleagues dismissed opportunities on the grounds that the facilities are not up to standard when in fact there are many ‘state of the art’ facilities in regional Australia. I visited Rockhampton Hospital recently and it was an amazing facility – but clearly in further need of medical staff. We need experienced doctors in regional areas to train the next generation, but we cannot expect these doctors to just turn up. The AMA has many ideas to bolster this crucial workforce and I hope with the new Government we can make some genuine progress in this regard.

The National Medical Workforce Strategy is still far from completed, but that does not mean we can be idle waiting for the recommendations. We need the new Government to understand this issue properly and be prepared to take action for the good of the profession, patients and communities without eclipsing political hubris or desire poisoning the outcome.

At a recent meeting in Canberra, a colleague said: “You can’t make doctors go where they don’t want to and you can’t make them work in what they don’t want to.” This is exactly right, but you can provide medical students and junior doctors with up-to-date data on which specialties are in over and under supply and provide enticing training opportunities that help balance our workforce (e.g. psychiatry would do better if junior doctor experience and training was not rooted in public teaching hospital departments). 

We can do better if we map out areas of priority for medical workforce and highlight training opportunities there, you can provide specific and targeted incentives when you know who you need and what you need, and you can begin to change the narrative on what medical practice outside the cities is actually like. We don’t need a strategy to start this work, we need a Government willing to take action in the direction many are pointing.


Published: 20 May 2019