The Australian Rural GP Pipeline within the Australian Health

Workforce Framework

Year 10 - 12 StudentsM

edical StudentsIntern - PG

Y 1

PGY 2 & PGY3

GP Training: Rural Pathway & General Pathway

Urban GPs Rural GPs

Specialist Training

Author: Chris J Mitchell, CEO, Health Workforce Queensland, Brisbane, Australia. Contact: cmitchell@healthworkforce.com.au Co-author/s: Michael Thornber, Director, Michael Thornber & Associates, Sydney, Australia

Kris Battye, PhD, Kristine Battye Consulting Pty Ltd, Orange, AustraliaColin White, PhD, Manager Data and Research, Health Workforce Queensland, Brisbane,

Objectives• Identify the key factors influencing GP supply

• Measuring the gap between supply and requirements

• Develop solutions to narrow the gap between the supply and requirements

MethodsA literature search of official reports on the number of graduates from Australian Medical Schools and workforce projections was conducted in 2008.

The Australian Health Workforce framework was developed by Health Workforce Queensland and a number of service partner consultants.

Summary of Findings• It is clear that there will be an increase of Australian trained medical graduates by up to 86%. It is

also clear that there is no comprehensive plan to accommodate these increases. The “pipeline” is not ready.

• Health Workforce Queensland has endeavoured to present this picture so as to examine the impact, implications and to consider some potential solutions.

• Strategies will be required to resolve the supply and requirement factors as well as infrastructure requirements to accommodate the training and service needs.

• The impact of the increased medical graduates at each stage requires new approaches and the policy implementation and coordination systems will require significant change.

ConclusionSolutions & Policy are required;

1. Establishment of Primary Health Care Policy & Funding to reduce demand on GPs• New funding arrangements • New models of care• New Roles and Other Health Professions• Healthy Lifestyle / health promotion, preventive health

2. Primary Health Care to meet Community Needs• Health Care needs of Community are known• Quantum and range of services defined to meet needs.• Health Workforce and Infrastructure requirements determined

3. Infrastructure Support for Rural Practices to facilitate Training• Additional Clinic rooms and Training rooms• Accommodation facilities for health workforce• Information Management and Technology• Supervisor support networks & resources

4. Workforce Supply• Coordinated system to attract, recruit & retain health workforce • Increase medical school places with placement supervision • Increased supports for International Medical Graduates

Explanation for FrameworkPrimary Health Care Policy and Funding The Values and Beliefs, the Paradigm, the Policy and the fundingIn Australia there is no national policy or comprehensive funding arrangement for primary health care. The new Federal Government has launched the development of a Primary Health Care Strategy.

The current primary health care provision is predominately accessed through a GP and hence funded through Medicare via item numbers. Recently there has been an extension of the ‘item numbers’ for rural and remote communities to allow doctors to involve and fund nurses and other health professionals to provide the health care. New models of primary health care and funding arrangements should provide improved health services to rural and remote communities. This will occur through the better utilisation of current roles of health care professionals and the creation of new health care professional roles.

Primary Health Care to meet Community Needs There are many factors that contribute to the provision of a viable health service and there is a range models of viable and sustainable service provision for rural and remote communities. The health needs of the community should inform the design of the health services as well as the needs of the health service providers and workforce. The agency has been facilitating the community based health planning based upon a methodology outlined below.

• Initial Assessment of the readiness of the Community to embark upon a systematic approach to their health workforce issues. This assessment includes the willingness of the support of the local community leaders as well as the health service professionals.

• Decision by the Agency to commence & engage with the Community to develop an agreed approach to the planning.• Environmental Scan Analysis and Strategic Issues. The analysis includes an assessment of the health status of the

community to identify the health needs of the community, as well as an audit of the current health service provision.• Options and Selecting the Most Appropriate. A range of options is put to the community for them to evaluate the

most appropriate for their situation.• Implementation, Monitoring and Evaluation. Many plans are written and left lying on shelves. The Agency recognises

the need for support in planning and implementing the agreed solutions.• (for a fuller explanation see “Solutions for the provision of primary care to rural and remote communities” - 2005 & “Methodology to

support development and implementation of solutions to Queensland Health Workforce Crisis” – 2006 – www.healthworkforce.com.au).

Infrastructure for Primary Health CareSome of the key components of a viable and sustainable health service and workforce are the supporting infrastructures including:

• Practice Management support such as business management systems and processes, financial and IT systems• Practice Ownership structures appropriate for the local situation. This is especially important in very remote

communities where there is not the threshold population level to conduct a viable private practice. Other structures are required.

• Workforce Support including recruitment, locums, education and training and family support are essential for the retention of a primary health care workforce.

• Appropriate Practice and Infrastructure to support clinical practice and teaching. This is seen as critical, since the increase of university placements and hence the demand for student placements in rural and remote practices is going to increase dramatically in the next few years. Many of the practices do not have the physical infrastructure to provide adequate training, coaching and mentoring.

• Physical Infrastructure will be required when there is a change of Primary Health Care Policy and Funding. More and different health service facilities will be required to accommodation the creation of Primary Health Care Teams.

Health Workforce Supply The supply, distribution and attributes of the health workforce needs to match the model of primary health care and the associated funding models. It is acknowledged that there is a global shortage of health workers. Australia as a whole is facing experiencing a shortage of health care workers. Rural and remote communities experience the impact of this shortage to a greater degree.

International Medical GraduatesIn recent years Australia has increased its reliance upon International Medical Graduates due to the lack of Australian Trained Doctors. The International Medical Graduates have and continue to make a significant contribution, being 50% of the Queensland rural health workforce. Australia recognises the moral and social justice issues of recruiting doctors from developing countries by signing the Commonwealth agreement and adopting the WONCA – Melbourne Manifesto 2002. This will have an impact of the supply of International Medical Graduates in the future. Apart from these issues, there are still many complications and barriers to the selection, recruitment and induction of International Medical Graduates.

Increased University Places for Australian Health Professionals StudentsDespite the opening of new Medical and Nursing Schools and the projected increase of graduates from other Medical and Nursing Schools, there is still a national shortage of doctors and nurses. It is clear that the projected number of medical school graduates (86% increase in medical graduates 2007 – 2012) will not be sufficient to meet the health care needs of the community, especially rural and remote communities. Nursing is facing an even bigger problem as the levels of retirement of the existing workforce increases.

Clinical Training Placements and SupervisionThe 86% growth in medical students will have flow-on effects throughout the whole medical and training system. This will include an increased need for clinical training placements during university education and vocational training in public and private hospitals, community clinics and General Practice settings. This will require an increase in the number of and distribution of competent and supported GP and hospital supervisors.

Australian Graduates, International Graduates & Australian Interns2004 - projections to 2016

1000

1500

2000

2500

3000

3500

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Australian Graduates

Australian Interns

Australian + InternationalMedical Graduates

GP training places & projected workforce requirements

350

450

550

650

750

850

950

1050

1150

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

No. of submitted ApplicantsNo. Training PlacesTraining places filledAMWAC Projections

66% increase in GP training places from

2009 - 2013

Australian Medical Workforce Advisory

Committeeprojected workforce entrants

requirements

Australian College Training Place requirementsProjections 2008 - 2013

1200

1700

2200

2700

3200

3700

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Australian + InternationalMedical Graduates, Interns inprevious year

All College 1st Year trainingplaces (MTRP)

increase in medical school graduates will require an 86% increase in College training places

Primary Health CarePolicy and Funding

Infrastructure for Primary Health Care

Health Workforce Supply

Implementation - the Decision Makers and Influencers- The Forums and Bodies

- the Agency Role and Communication Plan

Primary Health Care

320

639806

1129

1508

0

500

1000

1500

2000

2500

3000

3500

4000

Shortfall of 1st Year training posts 320 639 806 1129 1508

Anticipated 1st year posts (ex GP) 1357 1357 1677 1896 1963 2186 2565

AGPT anticipated GP training posts 600 600 600 700 800 900 900

Total 1st year training posts required 1957 1957 2277 2596 2763 3086 3465

2007 2008 2009 2010 2011 2012 2013

Extra 1st Year funded training places required each year

AGPT ANTICIPATED 1ST YEAR TRAINING PLACES

SHORTFALL IN 1ST YEAR ADVANCED TRAINING PLACES EACH YEAR

current level of 1st year GP advanced training places (N=600)

ANTICIPATED 1ST YEAR ADVANCED TRAINING PLACES REQUIRED (INCLUDING GP)

current level of 1st year advanced training places (N=1957)

Australian Health Workforce Framework

2007-2013