How different might our health workforce be – in composition, training and skills – if it reflected the community’s needs, rather than history, traditions, and professional demarcations?
It’s a question that merits not only the asking, but also some clear-headed attempts at negotiating a way between the vested interests that so often obscure the path to sensible answers in this area.
At least the issue of workforce reform is getting some hearing, with two conferences putting it on the agenda in recent days.
The organisers of this two-day conference that began today in Sydney are optimistic that the COAG driven National Health Workforce Taskforce has made “significant headway” in promoting a nationally coordinated strategy for health workforce planning, and that unified approaches are emerging in professional bodies, training institutions, health services, and regulatory infrastructure.
But they also note some of the problems: “Roles and tasks have remained in silos that have been in place for many decades. The current recruitment, training, and staff management systems are disjointed and health service and clinical management approaches have not readily adapted to changing demand.”
Meanwhile, the ANU last week hosted a forum on health workforce reform last week – you can watch Robert Wells talking about the need to share the evidence with the community here.
Dr Mark Ragg, who facilitated the forum, has written this account for Croakey:
“I was at a forum in Canberra on Thursday on health workforce reform organised by the ANU Primary Health Care Research Institute, and listened to Emil Djakic speak.
Now a bit of background that is bleeding obvious to anyone who’s ever been near workforce reform. To get a better workforce, there needs to be a devolution away from a doctor-centric health system towards one that better uses the skills and abilities of a wider range of players.
There are many discussions around the best way to do that, and to make sure it improves patient safety, but few outside the medical profession believe the current system is the best way. But such a change would involve a slight loss of control for doctors, in some areas. Some doctors are fine with that, others are not. But issues of control are nearly always behind the fiery debates that always take place.
Well, in speaking about the primary health care workforce Emil, who is chair of the Australian General Practice Network, said that he wasn’t convinced that reform was needed, and that he wasn’t sure of the direction any reform should take, and that what was needed was more research. Any changes made had to be based on ‘data, data, data’, he said.
Fine. Surprising, but fine.
After the forum, I spoke to two men from other doctors’ organisations who used similar phrases. ‘Data, data, data’, one said.
Coincidence? Possibly. Or a concerted approach by some doctors’ organisations to try to delay action while ‘more research is need’. Surely not.
We’ll see how effective such an approach would be. Warren Snowdon, who is Minister for Indigenous Health, Rural and Regional Health and Regional Services Delivery was pretty positive about the fact that ‘reform is going to happen – we promised it and we’ll deliver it’.
Hope he’s right.”
• Mark Ragg is adjunct senior lecturer at the Sydney School of Public Health, Sydney University, and director of the health and communications consultancy RaggAhmed.
• And on related issues…Does Australian medicine operate a “closed shop” that discriminates against overseas trained doctors? Find out more in this news story for the BMJ.
What would constitute the “data” that they’re talking about?
I don’t know what Mark was told, but if history is any guide, I’d assume the emphasis would be on quality and safety data. Those are the concerns traditionally raised when “others” are perceived as impinging on medicine’s domain. Another approach to data might be to look at what are the community’s biggest unmet healthcare needs. This approach might conclude that medicine’s trend to super specialisation is exacerbating rather than alleviating unmet needs.
The doctors aren’t the only problem in any reform they may not even be the be the biggest problem. Nurses are always enthusiastic about reforms that seem to take tasks from doctors and give them to nurses.
But nurses are far less enthusiastic about reforms that take tasks from nurses and give them to physios, or OTs or god forbid Allied Heath Assistants or even worse technicians who specialise.
I was at one specialised hospital in Europe a couple of months ago they employ very very few nurses and those they do are seen as clinical managers most work is done by technicians – most of them from catergories we haven’t even head of here..
We need technicians trained at TAFE level for Diabeties programs, Smoking ceasation, Cancer support, Obesity and weight loss fitness programs, monitoring of elderly and those with chronic illness.
we need to stop wasting GPs time with appointments for repeat scripts, appointments for work medical certificates, and even interpretation of results that can be done by others in consultation with the GP who should also be in consultation with Specialists.
If we sort a lot of the old guild/turf wars out in health we can probably get by on the GPs we have now.