Health Workforce 2025 Workforce projections for Australia Mr Mark Cormack Chief Executive Officer, HWA Organisation for Economic Co-operation and Development Expert Group on Health Workforce Planning and Management meeting 17 September 2012
About Health Workforce Australia HWA is an Australian Government statutory authority Our AIM is to secure a sustainable health workforce This workforce should have the capacity to meet the growing demands on Australia s healthcare system, arising from: an ageing population growth in chronic disease increased community expectation overall growth in utilisation
HWA s key objectives 1. Building capacity to deliver more fit for purpose health professionals more quickly and efficiently 2. Boosting productivity of the workforce and maximising their use 3. Improving distribution to ensure the health workforce is placed in areas and specialties where they are needed
HWA s key objectives HWA will deliver these objectives by: building the evidence for health workforce reform through planning, research and evaluation providing leadership to influence national policy and programs on health workforce innovation and reform working in collaboration with stakeholders to drive reforms and support a sustainable health workforce
HWA: Our four key programs We are working in four key areas: Workforce innovation and reform Clinical training reform International health professionals Information, analysis and planning
KEY AREA ONE: Workforce innovation and reform Guided by the National Health Workforce Innovation and Reform Strategic Framework for Action 2011-2015 Framework approved by the Standing Council on Health in August 2011 Delivering a national program of health workforce innovation and reform by leading and adding value to current reforms and innovations being undertaken in the health and education sectors
KEY AREA TWO: Clinical training reform Support growth and reform in clinical training Build clinical supervision capacity and competence Promote development of and increased use of simulated learning Organise and govern clinical training through integrated regional training networks
KEY AREA THREE: International health professionals Build intelligence and evidence on skilled migration Organise national strategy for attraction and retention Increase nursing and allied health recruitment and retention for primary healthcare services in rural and remote Australia Streamline and create more efficient pathways to practice Simplify access to information
KEY AREA FOUR: Information, analysis and planning National projections of workforce numbers and modelling the effects of different policy scenarios for a range of professions: Health Workforce 2025: Doctors, Nurses and Midwives (volumes 1 and 2) medical specialties in forthcoming volume 3 oral health workforce planning underway National data sets national statistical resource Specific workforce planning (e.g. oral health and mental health)
Health Workforce 2025 (HW2025) Volumes 1 and 2 released by Australia s Health Ministers on 27 April 2012 For the first time, we have a picture of national workforce planning projections for doctors, nurses and midwives It contains detailed modelling on workforce supply, demand, training and distribution It projects numbers required between 2012 and 2025 for: professional entry students postgraduate and specialist training
RATIONALE: To quantify the current health workforce To provide an impetus and consensus for reform by: gathering the evidence showing the need for action modelling the impacts of various policy options To embark on practical reform through collaboration
METHODOLOGY: Mathematical simulation modelling Stock and flow model Flows In Graduates Re-entries Increased hours Immigration Late retirement People entering and exiting the workforce (flows) periodically adjust the initial number in the workforce (stock) Current Workforce Flows Out Retirement Illness/Death Career change Decreased hours Emigration Future Workforce
METHODOLOGY: Supply input data Age and gender of the workforce: workforce was split into five year age and gender cohorts the working hours of each cohort were determined and changed as the workforce aged to capture the different working hours of the different age and gender groups new entrants to the workforce took on the characteristics of the existing workforce at the age they enter Exit rates from the workforce were calculated from the exits from each age cohort seen on progressive national workforce surveys Intention to retire was not used
METHODOLOGY: Demand Based on service utilisation rates for each five year population age and sex cohort These rates were applied to the projected population for each of the population age and sex cohorts, to derive the rate of change in demand over the projection period Where available, hospital separations data and occasions of service data were used to calculate an overall utilisation rate Practitioner to population ratio not used
METHODOLOGY: Scenarios Selection of scenarios was based on extensive stakeholder consultation with a focus on workforce reform A comparison scenario (baseline) and alternative scenarios were constructed Two purposes of the alternative scenarios: to explore the implications of possible alternative futures to demonstrate the sensitivity of the model to various input parameters
METHODOLOGY: Scenarios Scenario modelling of groups of policy options: innovation scenarios - productivity gain, low demand immigration scenarios - medium self-sufficiency, high self-sufficiency other impact scenarios - high demand, 5% initial undersupply, capped working hours Training numbers required under each scenario were calculated
METHODOLOGY: How robust is it? Some methodological limitations: data used was collected for a more general purpose and was self-reported difficulties in accounting for the impact of external factors, such as rapid technological change In the future: improved future data quality expected from national health professional regulation and the HWA national statistical resource an iterative process ongoing data collection and modelling with annual updates of projections
FINDINGS: Medical workforce results Scenario 2016 (Headcount) 2025 (Headcount) Supply Demand Gap Supply Demand Gap Doctors Comparison 93,687 89,903 3,784 109,225 111,926-2,701 Productivity gain 93,687 87,966 5,720 109,225 106,413 2,811 Low demand 93,687 80,655 13,032 109,225 90,536 18,690 Medium self-sufficiency 91,956 89,903 2,053 102,626 111,926-9,300 High self-sufficiency 90,398 89,903 495 96,686 111,926-15,240 High demand 93,687 100,019-6,333 109,225 135,349-26,124 Undersupply of 5% 93,687 94,430-744 109,225 117,615-8,389 Capped working hours 91,687 89,863 1,824 106,781 111,960-5,178
FINDINGS: Nursing workforce results Scenario 2016 (Headcount) 2025 (Headcount) Supply Demand Gap Supply Demand Gap Nurses Comparison 296,552 316,632-20,079 280,442 389,932-109,490 Productivity gain 296,552 309,705-13,153 280,442 370,435-89,993 Low demand 296,552 282,551 14,002 280,442 311,797-31,355 Workforce retention 318,578 316,715 1,863 367,240 392,086-24,846 Medium self-sufficiency 292,370 316,632-24261 260,114 389,932-129,818 High self-sufficiency 288,606 316,632-28,025 241,819 389,932-148,113 High demand 296,552 353,109-56557 280,442 473,565-193,122 Undersupply of 5% 296,552 329,657-33,105 280,442 402,997-122,555
DOCTORS: What did we learn? Short term: supply of doctors stable however a maldistribution across Australia By 2016: insufficient specialist training places for projected graduates Dependence on immigration creates ongoing risk
NURSES: What did we learn? Short term: supply of nurses is stable Long term: significant shortfall (109,490 by 2025) due to: ageing workforce poor retention rates population health trends Some areas of nursing are especially at risk in terms of supply: mental health and aged care
GEOGRAPHIC DISTRIBUTION: What did we learn? Geographic distribution of the workforce remains a significant concern in particular for doctors Vital that the projected increases in the supply of doctors are distributed to where they are most needed Current policy settings not capable of achieving desired shifts in distribution
IMMIGRATION: What did we learn? The current health professional workforce in Australia is highly dependent on immigration for doctors and nurses Changes to temporary migration can significantly impact the short-term need for health professionals by managing short-term fluctuations in supply Measures to improve self-sufficiency will require concurrent additional effort in training and workforce reform
HEALTH WORKFORCE 2012 VOLUME 3: Medical specialities Will provide Australia s first major, long-term national projections for doctors at the medical specialty level Will provide an impetus for reform, by showing: the need for action the impacts of possible future changes Extensive consultation was conducted to: discuss data sources, assumptions and results obtain feedback on factors likely to affect future workforce supply and demand
HW2025 Volume 3: Scenarios Service and workforce reform: incorporates a combination of low demand and productivity gain that were included in Volume 1 Medium self-sufficiency Capped working hours Registrar work value Comparison scenario 25
HW2025: Policy options Policy options linked to selection of scenarios strong focus on reform responses in both workforce and training Outcomes used as a burning platform to promote system reform
DOCTORS: Policy options Innovation and reform can have a significant effect on the anticipated demand for doctors through: small changes in productivity national coordination of the training pipeline to ensure graduates have a clear postgraduate training pathway Broader reform, including in training, must accompany any move to decrease the historic high levels of immigration otherwise anticipated supply will not meet demand
DOCTORS: Policy options Rather than increasing sub-specialisation there is a need for greater emphasis on: primary case GPs general physicians general surgeons Need for improved coordination of training to improve geographical distribution and distribution among specialties
NURSES: Policy options We need to close the projected gap between supply and demand Better retention of nurses will have the most significant impact, delivered by: recognition, respect and cultural change improved job satisfaction: allowing nurses to work up to their level of training ( top of their licence ), extending scope of practice and reducing low-skill tasks greater flexibility in work practices
NURSES: Where to from here? In addition to retention, other reforms are needed: improved productivity: workforce reform, technology quality, targeted training: system capacity, pathways sound immigration policy: ease of practice with maintenance of Australia s high standards
HEALTH WORKFORCE 2025: Where to from here? Three streams of work are underway: 1. Sector studies (the first of these being the oral health workforce plan) 2. Ambulance officer and paramedic workforce study 3. Other health professions
Oral health workforce plan Includes the following occupations and professions: dentists hygienists dental therapists oral health therapists prosthetists dental assistants dental technicians
Oral health workforce plan Skill mix methodology based on modelling different scenarios including: current skill mix using the mix of dentists/ hygienists/ dental therapists/ oral health therapists increased usage of hygienists/ dental therapists/ oral health therapists hygienists/ dental therapists/ oral health therapists expanded scopes of practice optimal oral care for all Australians government initiatives Other scenarios will be developed in consultation with stakeholders
HEALTH WORKFORCE 2025: Other health professions stage one Profile from available data: Australian Bureau of Statistics (ABS) Labour Force Survey registration and profession collected data demand measures from existing data 1996, 2001, 2006, 2011 Census of Population and Housing: using occupation codes only refined definition based on relevant industry, field of study, level of education and occupation Completion by April 2013
HEALTH WORKFORCE 2025: Other health professions stage two Additional sector plans: mental health maternity services aged care These are aligned to HWA s program of workforce innovation and reform ensuring linkage of planning and reform efforts
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