Event Q&A
Q&A
How do rising OOP costs relate to what’s happening in these trends?
Professor Anthony Scott -
Please refer to the figures on bulk-billing and fees I presented which are in the report. Out of pocket costs also include other things and are best seen from the patient's perspective, which we don't look at directly in this report.
Can this telehealth data be disaggregated to MMM3-7 areas?
Professor Anthony Scott -
Not with the publicly available Medicare data I used, but DH will be able to do this internally.
There was a small (0.5%) difference in growth of GPs in urban versus rural areas - is this small difference statistically significant? Also, given the heterogeneous population growth rates in urban vs rural, how do GP growth rates compare when taking the population into account? i.e. are we getting net growth in GPs per population in rural areas?
Professor Anthony Scott -
We will need to do more analysis on that. Also, we are only using headcount data not FTE, which is not available in the DH workforce data tool we used.
Associate Professor Susan Wearne -
Another source of data on this is the Report on Government Services. This shows that there has been net growth in GPs per population in rural but larger growth in urban areas. The National Health Workforce Dataset shows that the number of full-time equivalent GPs per 1,000 population generally increases with remoteness up to MM4 locations, as their roles are broader including public health, hospital, and emergency. The number then decreases significantly in smaller remote and very remote towns.
The health workforce includes more than doctors. With the move to greater interdisciplinary care, are we paying enough attention to achieving the "right mix" of doctors, nurses, allied health etc.?
Professor Anthony Scott -
No, I do not think we are. The focus is all on medical and face-to face in terms of current workforce planning efforts at a national level (as far as I know but I could be wrong). In a year of growth in doctors, the incentives for skill mix change are much less than if we had a shortage.
Associate Professor Susan Wearne -
The draft National Medical Workforce Strategy looks specifically at doctors to address many of the imbalances outlined in the ANZ-Melbourne Institute Health Sector report. The strategy recognises that to be successful we need to consider new and different models of care, and recognises that doctors work as part of health care teams. The Department of Health is also developing other strategies that consider interdisciplinary care such as the National Mental Health Strategy, the 10 Year Primary Care Strategy, and the Aboriginal and Torres Strait Islander Health Workforce plan.
Given the decline in the number of patients seen by doctors, what is the trend in average weekly working hours?
Professor Anthony Scott -
Doctors working hours are also falling (for men and women, and particularly more so for men), so it's an interesting point. Numbers increase but working hours fall, so the net change in FTE supply might not be as great as we think. However, the differences between the growth in the number of GPs and specialists might get wider if we account for FTE, as GPs work fewer hours than non-GP specialists on average.
Dr Kym Jenkins -
Keep in mind that doctors working less hours and seeing less patients may not necessarily be connected.
Associate Professor Susan Wearne -
The National Health Workforce Dataset shows that between 2015 and 2019, the average weekly hours for doctors fell from 42.4 to 41.8. This is most likely due to there being more emphasis on work/life balance and doctors juggling family commitments with work.
How do we restrict places in medical specialties and channel doctors towards general practice without being accused of constraining/restricting trade?
Professor Anthony Scott -
The ACCC is always interested in colleges' decisions to alter the number of places, however, I guess any changes need to be backed up by good evidence of shortages/surpluses.
Associate Professor Susan Wearne -
The ACCC has advised that regulating the number of training places may not breach anti-competitive laws, if it is clearly in the national interest, as agreed by governments based on national data.
Just wondering what the speakers can say about a role for flexible work hours for a sustainable workforce and doctors' wellbeing - particularly for doctors in training where many training programs in practice are not flexible?
Professor Anthony Scott -
As far as I know, many training programs offer flexible hours and part-time training but few take it up as it is still perceived by seniors to be damaging to their career because it reflects a lack of 'commitment'. We have data that when a female doctor has a child they are likely to stop training completely for a year, then resume, rather than go part-time.
Dr Kym Jenkins -
Where feasible, flexibility in hours are important for doctors' wellbeing.
Associate Professor Susan Wearne -
One of the draft National Medical Workforce Strategy priorities is to reinforce the importance of flexible training and flexible careers to promote doctors' well-being. This is an issue that all governments and workplaces need to consider.
How can current medical students/junior doctors/early trainees alter their thinking, priorities and lifestyle planning to better align with the potential rolling out of the NMWS?
Dr Kym Jenkins -
They should be encouraged not to foreclose on career choice too early. An extended two-year internship in PGY2 will help.
Associate Professor Susan Wearne -
One area of consideration in the draft National Medical Workforce Strategy is how we can provide more information to medical students, junior doctors and trainees regarding the need for different specialties. This needs to be linked with better information regarding the number and location of training places and the chances and cost of selection.
What are the speakers' thoughts on the benefits that can be implemented to incentivise doctors to voluntarily practice or train rurally rather than be 'forced' as a requirement of training programs or accreditation pathways?
Professor Anthony Scott -
I guess incentives might coerce, however our MABEL research shows that incentives don't really work and are not large enough. They might work for new fellows, but not for established doctors. References to these studies are in the ANZ report.
Dr Kym Jenkins -
We need to ensure entitlements are carried across all settings.
Associate Professor Susan Wearne -
Medical students and trainees can be recruited into rural placements, scholarships and other programs and have rewarding experiences. Pre-vocational and vocational training is metro centric and there are often not enough opportunities for those trainees that would like to relocate to rural areas. High quality supervision is also an important factor in training. Rural training can offer non-incentivised benefits such as broader scope of practice, gaining clinical courage to face unexpected challenges, learning how to access remote support and developing social connectedness to local communities.
Do you have data on the number of hours worked by doctors rather than doctor numbers? Doctors - especially GPs - do not work the same hours that doctors did 20 years ago. My view is that there may be more GPs but the hours worked are less.
Professor Anthony Scott -
Yes, you are correct. Hours worked have been falling for men and women, but particularly more so for men, who were working longer to begin with.
Dr Kym Jenkins -
However, working less hours may actually lead to better care delivered if the doctor is less tired and burnt out and is "enriched" or rejuvenated by a life outside of medicine.
Associate Professor Susan Wearne -
As mentioned earlier, the National Health Workforce Dataset shows that between 2015 and 2019, the average weekly hours for doctors fell from 42.4 to 41.8. This is most likely due to more emphasis on work/life balance and doctors juggling family commitments with work.