According to the National Health and Health's Reform Commission, “ The health of our people is critical to our national economy, our national security and arguably, our national identity. Our own health and the health of our families are the key determinants of our wellbeing ”. This statement highlights the pivotal role of doctors in the delivery of medical care in Australia. Hence, an adequate supply of trained health professionals is important to maintain the health of the public and to contribute to Australia’s social and economic well-being.
This article examines the demographic characteristics of Australian doctors including the commencing medical students and interns, and the role of the government in helping the medical workforce.
THE MEDICAL WORKFORCE
According to the Australian Institute of Health and Welfare, there are 95,000 registered medical professionals (including provisionally registered) in 2013. Of this number, many held a general registration (76,358) and most of them also hold a specialist registration (45,866). From 2004 to 2013, there has been an increase by 39% on the total number of registered medical practitioners (excluding provisionally registered). From 65,499 registered medical practitioners in 2004, it increased to 91,467 in 2013. There has also been an increase in the number of employed doctors over the same period.
TYPES OF PRACTITIONER
Medical practitioners have different roles. These include clinicians, researchers, administrators, and teachers. Clinicians or those doctors who spend most time working on the diagnosis, care and treatment of patients are divided into general practitioners, specialists, hospital non-specialists and specialists-in-training.
1. General practitioners
General practitioners are primary care practitioners who are not oriented to a specific medical specialty but rather offer a holistic treatment to patients of all ages. From 2004 to 2013, the growth of supply of general practitioners in Australia has remained steady, ranging from 108 per 100,000 population in 2013 to 113 in 2007 and 2009.
These are doctors with a qualification awarded by an Australian specialist college to treat certain conditions. The number of specialists has also seen a steady rise from 2004 to 2013, from 110 to 113 per 100,000 population. Of this figure, the ‘physician’ was the broad specialty group with the highest number of practitioners (20.9%). Surgery comes second with 15.6% of clinicians.
Specialists-in-training are doctors who have been accepted by a specialist college into a supervised training position.
4. Hospital non-specialists
Hospital non-specialists are doctors who are employed in a salaried position in a hospital who do not have a recognized specialist qualification and who are not undergoing training to gain recognition as specialists. These include resident medical officers, interns, career medical specialists, and other medical practitioners.
Historically, the field of medicine is dominated by male doctors, but the difference is becoming less pronounced. In 1996, the Australian Medical Workforce Advisory Committee pronounced that female doctors are increasing in numbers at a faster rate than the male workforce. They projected that female doctors will comprise 42% of the workforce by 2025. In 2013, the medical workforce has seen a 38.6% increase in female participation.
Although female doctors are growing in numbers, they are the least represented among specialists. This may be because of the length and structure of training, family and work considerations. But like their increased involvement in medical practice, female doctors are also becoming more involved in specialties. As of 2013, there has been an 8% increase from the 20.3% representation of female specialists of 2004. Among the specialties, females are highly represented in anesthesia, gynecology, obstetrics, and psychiatry. Meanwhile, they demonstrate low participation in surgery.
Australia’s population is ageing and this can adversely affect the supply of medical workforce. This demographic change means a smaller pool of working age from which Australia can draw its health workforce.
From 2004 to 2013, the median age for employed male doctors has remained at 48 years. Meanwhile, the average age for female practitioners slightly changed from just below 41 in 2004 to just over 42 in 2013. Although the median ages for male and female doctors do not vary at all, their age pattern demonstrates a great difference. Male doctors substantially belong to the older group with 90.4% of them belonging in the 75 and up age group. Female doctors on the other hand have a bigger number in the 20 to 35 age group (52.5%).
The ABS Survey of Employee Earnings and Hours of 2012 states that the average earnings of fulltime doctors who do not hold managerial positions is $ 2,862.30 per week. The median pay for male doctors is $3,015.60 while female medical practitioners earn $1,226.40 on average.
GRADUATES AND INTERNS
According to Health Workforce Australia, the medical school intake in Australia has been expanding since 2000, hence doubling the number of commencing students from 1,660 in 2000 to 3,469 in 2010. Throughout the years from 2000 to 2010, female medical students have comprised half of the population of commencing medical students. This increase in the number of commencing students has raised the number of commencing interns by more than 56% from 2004 to 2010. It is expected that these numbers will double over the years.
AUSTRALIAN GOVERNMENT AND THE MEDICAL FIELD
Recognizing the importance of the medical field in maintaining the nation’s well-being, the Australian government has always worked hand-in-hand with the medical workforce and institutions.
The Australian government offers support to medical students through bonded schemes. The first of these is the Medical Rural Bonded Scheme which provides 100 scholarships annually to Australian citizens or permanent residents. In exchange, students agree to practice in rural areas for six years upon completion of internship. The second scheme, the Bonded Medical Places Scheme, also provides extra university places for students who wish to study medicine. Students under this scheme agree to work in areas where there is a workforce shortage. Unlike the Medical Rural Bonded Scheme, there is no direct funding to students in Bonded Medical Places Scheme.
Through the Council of Australian Governments (COAG) and the Australian Health Ministers Conference (AHMC), Commonwealth-funded domestic medical graduates are guaranteed internships in public hospitals and access to clinical placements.
3. Professional Development
Because the medical field is dynamic and changing, the Australian government supports development in this profession through:
3.1. Australian General Practice Training (AGPT) – This is an Australian Government funded postgraduate vocational training for medical students pursuing general practice
3.2. Specialist Training Program (STP) - This is a government-initiated program that funds accredited health organizations to support specialist training rotations in settings beyond traditional public teaching hospitals.
Although the supply of the medical workforce in Australia has seen an increase, the changes in the demography of the nation’s population and the increasing demand for health services continue to pose challenges. However, government-initiatives have been put in place to support the field of medicine and these big steps for the future of the Australian medical workforce.