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“Nation-building” health workforce planning needed

David Townsend, a third year medical student from the University of New England, and National Chair of the General Practice Students Network, argues that Australia needs to take a ‘nation-building’ approach to health workforce planning to ensure we can meet our future health care needs.

Australia is facing a critical shortage of doctors and nurses. To try and plug the gap we’re importing foreign trained doctors and nurses.  Meanwhile, new Australian-trained medical and nursing graduates are being prevented from completing their training resulting in an onslaught of health graduates who are unable to qualify to work in Australia. Until the State and Federal governments work together to develop a comprehensive national plan to address training shortfalls, Australia will continue to produce health graduates who cannot work in our health system.

Australia is fast running out of time to find a solution to an impending training crisis that threatens the sustainability of our entire health system. In the past, governments have shown a willingness to work together on nation-building projects like the Snowy Mountains Scheme and the highways, railways and transportation that connect our communities.

These projects forged our strong national spirit and transformed Australia from a collection of colonies to a brave and independent nation.  Now Australia needs our State and Federal governments to embrace this same spirit to find a viable long-term solution to training shortages that will impact the future health of every Australian.

In recent weeks medical students across Australia have risen up in protest against the ongoing shortage of internships, a compulsory training year required for medical students to complete their qualification. We have been telling the stories of 182 Australian educated international students who have missed out on an intern position, without which they cannot stay to help address the critical shortage of doctors in communities across Australia. We have told their stories on the streets, on social media, in the press and in the offices of our state and federal members.

One such story is that of Eleasa Sieh, a final year student at the University of Queensland. Eleasa is an international student from Canada who has trained for the last 4 years in the Australian health system. Her Australian fiancé is about to begin Rural Generalist training and Eleasa would love to stay with her partner in Australia to work as a rural GP. But to begin her training she first needs an internship. Instead, we’re sending her back to Canada with over $250,000 worth of debt for an incomplete qualification.

The reality is we can’t afford to lose these graduates. Health Workforce Australia (HWA), the Commonwealth authority established to advise State and Federal health ministers, has predicted that by 2025 Australia will be short 2700 doctors. This is assuming we continue our current rate of importing overseas doctors and that State and Federal Governments succeed in finding intern places for the 182 medical school graduates who are currently unable to continue their training in Australia.

The intern crisis is just the tip of the iceberg. In recent days there have been reports from Victoria and Queensland of over 700 junior doctors who cannot continue on to the next stage of their training because their state Health Departments have chosen not to reemploy them.

The predicted shortfall for nurses will be even worse, with HWA projecting a shortage of over 110,000 nurses by 2025. However, recent reports suggest up to 40% of Victorian nursing graduates will miss out on a graduate year position contributing to a total of over 1000 Australian nursing students who will be unable to complete their RN qualification this year.

Australia is already facing a shortage of health professionals. The Rural Doctors Association of Australia estimates that there is a shortfall of 1800 doctors in rural communities today. Much like the wider population, the medical workforce is ageing. One third of Australian GPs are over 55 and over 38% of nurses and midwives are over 50 years of age. Without urgent and concerted action at all levels of government the current and future workforce shortages will impact all Australians. Waiting times will increase, access to a dwindling supply of GPs and specialists will become even more difficult and the current inequalities in rural and remote health services will deteriorate further.

Despite repeated warnings from the Australian Medical Association, the Australian Nursing Federation, the Australian Medical Students Association and numerous other industry bodies, successive governments from the last 10 years have failed to adequately address these issues. Our current representatives in Government have an opportunity to correct past mistakes and turn the tide before it’s too late.

Australian universities are producing increased numbers of medical and nursing students. Previous Governments requested increased graduate numbers to meet forecasted workforce shortages. We need our current Governments to look to the future and commit to funding the necessary training positions for every single new graduate to finish their training and secure a sustainable health workforce for Australia.

Building this capacity will require significant cooperation between state and federal governments, hospitals, universities, training providers and the entire health sector. Additional training places for graduates will need to be found in public hospitals, private hospitals and in the community. There are viable solutions waiting in the wings but we need our state and federal governments to demonstrate the political will to make it happen.

David Townsend is an active member of Medical Student Action on Training, a medical student initiative to raise awareness of the ongoing #interncrisis

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