australian medical workforce reforms and challenges robert wells,october 2004
TRANSCRIPT
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AUSTRALIAN MEDICAL WORKFORCEReforms and challenges
Robert Wells,October 2004
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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
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A DECADE OF REFORM (1)
Early 1990s: GP reforms, eg ‘VR’; GPET 1995: AMWAC created 1996: new arrangements for access to provider
numbers
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A DECADE OF REFORM (2)
1996: Medical Training Review Panel 1997: pre vocational medical councils nationally 1997: specialist training selection reforms
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A DECADE OF REFORM (3)
1997: reforms to assessment of IMG doctors 1999: rural education- UDRHs & RCSs 2000: AMC accreditation of specialist training
programs
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A DECADE OF REFORM (4)
2000: Rural Bonded Medical School Places 2001: Outer Metropolitan medical workforce scheme 2000-02: specialist training outside hospitals pilots
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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
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A DECADE OF REFORM (6)
Workforce planning for nurses & other health professions: AHWAC
Link workforce planning & policy: AHWOC Nursing reviews Nurse practitioners
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A DECADE OF REFORM (7)
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
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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
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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
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GLOBAL ISSUES/DEMOGRAPHICS
Australia’s competitiveness at risk in a global health workforce market
Long term outlook mixed: declining birth rates- ‘2020 problem’
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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
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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
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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
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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 system-
hospital dependent Outdated learning methods, eg apprenticeships vs. skill centres ‘one size fits all’
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3 POINT PLAN for TRAINING
Needs major attention Getting it ‘right’ is basis of continuing excellence of
our health system
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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
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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 $
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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
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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
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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)