Do available predictions of future medical workforce requirements provide a sensible basis for planning? Yes

The most recent Health Workforce Australia report provides an interesting model of future medical workforce requirements.1 Modelling the future is always hard, and the Health Workforce Australia model is but a blunt instrument. Various scenarios are presented, ranging from a shortfall of 2700 doctors by 2025 if the status quo is maintained (ie, health services are provided as they are now, with no change in models of care, there are no productivity gains, and there is no development of a prevention agenda) to an excess of nearly 3000 doctors if we achieve a 5% productivity gain, or an excess of 18 000 doctors if demand is reduced by 2%. These targets for increased productivity and reduced demand are not large when you consider that the Productivity Commission report of 20052 suggested that the health system (particularly the public system) was running at about 80% of its potential capacity (ie, 20% inefficient). I suspect that this has improved, but not by much. We could increase the number of patients we see, reduce waiting lists, and make a real difference to disease by cutting through bureaucracy and using assistants to improve our productivity. We could develop remuneration schemes that reward productivity and good outcomes, rather than continuing to use the uncapped fee-for-service system that generates large incomes for proceduralists3 without always leading to optimal patient care.

Prevention of chronic disease now will help ameliorate future demand. For example, obesity produces over 50% of the disease burden of diabetes and nearly 20% of the burden of cardiovascular disease in Australia,4 and it generates over $8 billion in costs per year. If we are serious about disease prevention, this surely is the low hanging fruit. Doing something about this problem now will influence demand on health services in 2025 in a major way.

But the other real change has to be in the way we deliver health services, and this will affect the number of doctors we do or don’t need. Australia has a “Rolls-Royce” health system, but significant numbers of patients only require a “Mini”. With chronic disease and an ageing population, we need to develop a large number of assistants — to work with nursing staff, physicians, allied health professionals, and “health navigators” to guide patients through our incredibly user-unfriendly health system. This would enable people to access the care that they need equitably and at reasonable cost.5 Such assistants could be trained to a set of competencies and work very much as part of a team, as occurs in other parts of the world.6,7 Much resistance to assistants comes from the professionals groups (including the unions). Governments in Australia should defy these self-interested groups and get on with delivering health care. Use of communication or other technologies could significantly alter how and where we can deliver services. Telemedicine will be a boon to rural communities — linking them to specialist services in larger centres8 — but will also allow generalists to link with physician assistants, nurse practitioners and other members of health care teams who may be more willing to work in small communities, where we will always have difficulty attracting doctors.

So let’s use workforce modelling for what it is — an exercise from which you get out what you put in — by applying it to scenario planning. What those scenarios will surely say is that our health costs are out of control, we need new models of care and education now, and any vice-chancellor who considers opening a new medical school should be given a long sabbatical in Africa, where new medical schools will make an enormous difference to the population!