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

Health Workforce 2025

Workforce projections for Australia

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:

Flows In Graduates

Re-entries

Increased hours

Immigration

Late retirement

Flows Out Retirement

Illness/Death

Career change

Decreased hours

Emigration

Current Workforce

Future Workforce

Mathematical simulation

modelling

Stock and flow model

People entering and

exiting the workforce

(flows) periodically

adjust the initial number

in the workforce (stock)

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 mal-

distribution 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

25

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

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

For more information

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