A declining health workforce: what’s the answer?

Between 1980 and 1990, the number of doctors and nurses in Australia increased dramatically. Frightened by rising health costs, the federal government deliberately reduced the number of people studying to become doctors or nurses.

In hindsight, the government didn’t realise just how big a job it was to increase numbers again once they fell. It didn’t realise how bad chronic disease and other health issues were going to get in an ageing society. And it didn’t realise how much health workers, like everyone else, wanted to work more normal hours.

For example, doctors cut their average working week by about 3 hours between 1997 and 2002, which doesn’t sound a lot, but every 30-minute reduction is the equivalent of having 500 fewer doctors across Australia. This trend continues and consequently doctors have become far less available.

And the situation is likely to worsen. Lots of doctors are getting older and are looking at retiring. Baby boomers make up more than half of the doctors, nurses and medical workforce. Many female doctors only work part-time and most younger doctors won’t pursue the numerous hours once worked.

Issues such as shorter hours and retirement mean we could be losing doctors faster than they are graduating.

It’s already so bad in some areas that many outer-metropolitan areas are unable to attract Australian-trained doctors, even when the federal government offers them $20,000 to move there. They just aren’t willing to work 45 minutes away from the centre of the big city. Imagine what it’s like in remote areas.

Politicians talk about better use of nurses, which is a great idea. Many doctors already want to work as a team with nurses, but where will the extra nurses come from? Australia-wide, there’s already a shortage of about 30,000 nurses and their average age is in the mid-40s. So nurses are part of the answer but not the whole answer.

Overseas doctors are also clearly not the answer to shortages in general practice and hospitals. They are good workers and we value their contributions. But their own countries need them as much as or more than us and so do other Western countries, such as Canada and Britain, who will increasingly compete with us for this already scarce resource.

So, how else can we resolve the workforce shortages? The immediate response is to call for training more doctors and nurses. That’s certainly important.

But it’s also important to remember that the number of people available to enter study and the workforce is falling rapidly. Because more of us are retiring than there are kids entering the workforce, the overall growth of the workforce is slowing from 220,000 new people in 2002 to around 14,000 per year by about 2020.

Given that a growing economy can need about 200,000 new people a year, we will eventually not have enough people to train for medicine, nursing, engineering, teaching, public service and every other job. People will pick and choose, and there’s no guarantee they’ll choose to be doctors or nurses.

So training more people is a good idea but we have only a very small window of opportunity to do it.

The most likely answer is to make best use of all our resources. In recent years, hospitals and private doctors have started working together more closely. That trend needs to be reinforced and supported to get the best use of every person we have.

Of course, the other answer is that the community needs to be taking more responsibility for its own health - making healthier lifestyle choices and reducing demand for medical services.

So who’s going to look after you when you get sick? There are no easy answers to that question.