Australia’s approach to ongoing medical workforce issues
It’s undeniable that regional and rural Australia has major issues with sustaining a permanent health workforce.
The question is – are locum doctors contributing to the problem, or are they helping to keep the system going?
Interested to learn more, I recently went looking for medical workforce stats and stumbled across a 2019 article that was posted by The Sydney Morning Herald (SMH). The article was called “The system will eat itself’: Alarm over the reliance on locums in NSW public hospitals.
According to the article, the growing number of doctors choosing locum work over permanent contracts has led to locum usage being as high as 38% in regional and rural NSW.
This growth in the number of locum doctors in Australia and increasing gaps in permanent vacancies made it difficult to build cohesive medical teams, reduced staff morale and the quality of patient care.
The article went on to say that doctors resorted to locuming due to a desire to find work-life balance whilst maintaining high financial rewards. The lack of commitment was also blamed on junior doctors who were not prepared to put up with ‘lives lost to intense work schedules’, or because they failed to get into the training scheme of their choice.
Needless to say, this article had a very negative view on the impact locum doctors had on our overstretched healthcare system. As a recruiter (who has placed many good locum doctors over the years!), it was depressing to say the least. I can only imagine how a locum doctor reading this must have felt.
What an outrageous bunch of money hungry, work-life balance seeking, non-committal (to intense self-sacrificing work), training scheme failures all locum doctors must be!
After a Bex and good lie down, I then sat back and thought about it on a deeper level. Something just wasn’t adding up here and my mind filled with questions.
Did doctors really leave permanent jobs because they were lured away by attractive, well-paid locum positions? Why are doctors being so non-committal to the system that trained them and were there other factors contributing to the chronic permanent vacancies?
I decided to look further into why permanent doctors were leaving good jobs to become locum doctors in Australia. Given money was a key feature in the article, I looked at salary surveys for permanent specialist doctors across Australia, US, UK, Ireland & Canada. It turns out, Australia is one of the best payers in the world! To top it off, specialist in private practice were often paid much more than what consultant locum doctors were earning.
I then spoke to several other recruiters to get their views on why there were so many permanent gaps, particularly in regional and rural areas. The overwhelming theme was the same. For the most part, the remuneration and benefits for permanent roles were often considered attractive. There simply weren’t enough doctors in the right areas – and even after spending hours of time promoting roles and creating well written advertising campaigns, they still got crickets.
There was also endless bureaucracy and red tape getting International Medical Graduates (IMG’s) into the country. Just about everyone had a story to tell about an IMG placement falling through after months of hard work and no return. Sadly, in some scenarios recruiters had stopped working on rural assignments as it was too much of a gamble to commit the time and effort. These roles were considered unfillable.
Surely something is wrong in a marketplace when recruiters give up?
I then reached out to several specialist doctors to get their views on why they had left a permanent role or would consider leaving their role in the future.
The common themes that came through were excessive workloads, fatigue, burnout, inflexible contracts, lack of career advancement, difficult peer relationships, conflict with management, poor workplace cultures and sadly – not feeling valued. With a lack of quality education and social or cultural connections, long term rural living also presented its own set of challenges.
Overall, the motives for leaving permanent positions were not unique to medicine and common across all industries. Interestingly, the temptation of earning higher financial remuneration from locuming was not a key factor in why these professionals would stay or go.
Still questioning the chronic permanent gaps that existed, I recalled reading past articles about the maldistribution of Australian doctors. I then found an enlightening article in The Conversation (How can Australia have too many doctors, but still not meet patient needs?).
According to The Conversation, there has been a heroic level of doctor production over the years. With 3.5 practising doctors for every 1,000 people and 4.4 per 1,000 in major cities, we’ve never had so many. In addition to the ongoing importation of IMG’s, in the last decade alone Australian medical schools have almost tripled the number of medical graduates.
Among wealthy nations, Australia was vying for the top spot, with only Denmark and Ireland in the same league of doctor-production for population.
With new incentives and improvements in the number of regionally based training programs, further gains have been made with a growing workforce of Rural Generalists now in our midst.
Yet despite the advancements and the feeling of being high on the leader board of a European song competition, our health workforce issues persist. So, the statement “we have plenty of doctors in Australia” still wasn’t up to the pub test it seemed, particularly in rural and regional Australia.
According to The Conversation, the major problems with Australia’s approach to the medical workforce conundrum was down to 3 core unresolved issues: unfinished doctor production; excessive specialisation versus our need for more medical generalists; healthcare models and financing reform.
With an ageing population and more people with chronic and complex health-care needs, the problem of having the right workforce in place to meet our future health needs is now critical.
This article pretty much says it all and I felt like it got to the true heart of the issues at hand.
Maybe the SMH article was right about the system now eating itself. My gut feeling though was that locum doctors in Australia were not the issue here, and perhaps needed a bit more credit at times to help keep the system going.
So, whilst our healthcare leaders, policy makers, institutions and government continue to work on solutions to Australia’s great health workforce issues, I was left with one final question.
Are we doing enough to drive, and effect change for our permanently hungry Australian healthcare system?
Interested in other people’s views on this issue.