Why is MABEL Important?
The decisions made by doctors on how many hours to work, where to work in terms of sector, location and specialty, and when to stop work temporarily or permanently, all have profound effects on the health system. This includes effects on access to health care, the capacity of the health care system to reduce burden of disease and to meet demand, and the quality of care provided to patients.
Doctors' labour supply decisions are influenced by a complex mix of doctors' own preferences over work, leisure, family and lifestyle, the economic and non-economic incentives embedded in the way the health system is financed and organised, the culture of medical practice, and longer term trends in demand, demographic change, and the composition of the medical workforce.
The aim of this innovative research is to better understand the role and interplay of these factors through the analysis of the dynamics of the medical labour market in Australia.
The MABEL research team will produce evidence of international quality and of national and international relevance. This will be achieved by building research infrastructure around the MABEL longitudinal survey of doctors. MABEL has, since its inception in 2007, established itself as a national resource for medical workforce research with a growing international reputation. The MABEL research team will harness this initial success by using MABEL to leverage other research funding and ensuring that new knowledge generated is translated into policy and practice.
1. To describe and understand the determinants of trends in key measures of the labour supply of doctors
The research using the survey will focus on a number of key questions. Each research question will be examined with respect to a number of key labour supply decisions:
- The choice of number of hours to work;
- The balance between public or private sector work;
- The location of work;
- Specialty choice;
- The balance between clinical and non-clinical work;
- Whether to take an absence to work overseas, have parental leave and return to work; and,
- When to retire.
These choices involve trade-offs made by doctors amongst the costs and benefits associated with each type of decision. It is the costs and benefits of these decisions that can be influenced by policy and this is the focus of the research questions below:
- What is the impact of changes in economic incentives, including Medicare rebates and the level earnings, on labour supply decisions, working patterns and productivity?
- What is the impact of changes in family circumstances on labour supply decisions?
- How do the amenities and cost of living in different geographical areas influence decisions about where to work?
- What is the extent to which differences in job characteristics influence labour supply decisions?
- What is the relative importance of, and interaction between, the various determinants (1 - 4 above) of labour supply decisions?
- How does the effect of the above factors (1 - 4 above) vary across GPs, hospital doctors and private specialists, geographical areas, gender, and stages in the life and career cycle?
2. Evaluating and simulating the effects of policy change
Government policy and employers can influence the potential determinants of labour supply and workforce participation, such as changes in the level of earnings (e.g. changes in Medicare rebates; rural incentive packages; taxes); the characteristics of jobs (e.g. working in teams, use of IT, funding for locums and peer support); the nature and quality of education and training and family circumstances (e.g. childcare provision).
Changes in skill mix, and recruitment into deprived, remote and rural areas, will continue to be key areas of policy debate and development which will require a strong and rigorous evidence base. For example, in 2010 there were major changes to the federal government schemes that provide incentives for doctors to locate in remote and rural areas. Large increases in the number of doctors being trained has implications for changes in the working patterns and job satisfaction of junior and senior doctors.
The evaluation and simulation of the effectiveness of these policy changes are a key aspect of the research. Models of the determinants of the primary outcomes will be used to conduct micro-simulation of policy changes. Such analysis examines ex-ante 'what if' scenarios by predicting the impact of proposed policy changes on one or more primary outcomes.
3. Knowledge Exchange
Maximising the impact of research findings is a major goal of the MABEL research team. This requires effective linkages with the development of policy, its implementation and its evaluation. Our overall knowledge exchange strategy combines regular engagement and exchange with end-users based on our four pillars of knowledge exchange:
- The generation of knowledge based on user needs;
- Effective dissemination;
- Building capacity for the use of research by decision-makers;
- Tracking the application of knowledge in specific contexts.
4. Building capacity in health workforce research
The training of future health workforce researchers is a key aim of the MABEL research team. This will focus on:
- Postgraduate and post-doctoral training;
- The public release of de-identified data for use by other researchers;
- Use of MABEL survey materials by others;
- User support;
- International academic exchange;
- Building the capacity of researchers in knowledge exchange.