The Shortage of Doctors in Australia

Written by Delwin Keasberry Thursday, 26 January 2012 20:07

Greetings Readers! I was rummaging through some of my saved documents the other day when I came across an essay I wrote back in 2008 as part of the Strategic Human Resources module for my MBA. I would like to share it with you. It was written while I was in Australia but you might find some of my findings food for thought in relation to the local landscape. It is titled "The Shortage of Doctors in Australia". I am posting up the full essay for your reading pleasure. (I got a Distinction for it so it is worth the read but be warned, it's over 1,500 words in length...without graphics. *grin*)

"The Shortage of Doctors in Australia"

Executive Summary
In recent local headlines, Bildstien (2007) explains ‘southern suburbs doctors have been asked to stop sending patients to the Flinders Medical Centre emergency department because of overcrowding’. Owen (2007) writes the Lyell McEwin Hospital’s ‘intensive care unit…faces closure unless urgent action is taken by the State Government to address staffing shortages, doctors’.

Today, Australia is experiencing the consequences of policy choices made in the past. I have themed this assignment on the present Australian shortage of doctors. Within the constraints of this assignment, I intend to present my media findings based on these 3 human resource management topics:
1.    Regional Recruitment & Retention: An ad hoc approach
2.    Human Resource Planning: Forecasting Supply and Demand
3.    Strategic Human Resource Management: Questionable Allocations

These human resource management topics overlap and argue crucial considerations, mostly on a macro level. Current findings show awareness, but unfortunately, my key findings indicate suggested initiatives offer only short-term relief. Ironically, to the healthcare industry, keen on preventative measures, there is no immediate cure.

Critical Analysis

> Challenges to Recruitment
Stone (2006, p. 188) stresses the right person for the right job. I have noticed that the current approaches in media findings to recruitment are ad hoc. Numerous incentives have been introduced aimed at younger doctors. The Herald Sun (2007) notes, increasingly, payment incentives have been introduced to promote recruitment to rural hospitals. Hall (2007) writes ‘doctors are also being offered incentives such as the use of a car, mobile phones, accommodation and free air travel to work in the country’. Note worthy, Miller (2007) reported that $500,000 is being offered as incentive to lure doctors to the regional town of Temora, New South Wales.

Also, there is an acute shortage of doctors in Australia. McKenzie (2007), the Herald Sun (2007), Miller (2007) and the Sydney Morning Herald (2007) concur that the shortage of doctors, particularly in regional Australia, is at crisis point. Bass (2006) describes the shortage as a ‘medical vacuum’. This shortage is the foremost challenge to recruitment.

> Retention: Finding the balance
Additionally, the regional retention of doctors is a challenge. Work-life balance was a distinct issue. The Sydney Morning Herald (2007) observes that workloads are stressful in rural hospitals and practices. This is highlighted by Morley (2007) who describes ‘Dr. Tony Balston works six weeks straight and is on call 24 hours a day as the only doctor in the Darling Downs centre of Jandowae’, and notes this lifestyle is typical of any regional doctor.

Bouvier (2005) highlights the importance of a work-life balance, and this workload simply does not appeal to generation x and generation y practitioners. Furthermore, Grabmeier (2005) and Critchley (2004) discuss that younger doctors no longer want to work 100 hours a day as compared to their seniors.

Another indirect hindrance to regional retention is lack of clinical training opportunities. The Herald Sun (2007), Mckenzie (2007) and Shepherd (2007) discuss the ill-effects of poorly planned initiatives introduced by the federal government. These schemes are widely criiticised, particularly by the Australian Medical Association (2006) labeling them ‘unpopular, unfunded and ultimately unworkable’. Conversely, McLean (2007) finds that an effective training and development program has shown positive retention results in the Northern Territory Clinical School.

Summary of key findings
Stone (2006, p. 187) defines recruitment as ‘the process of seeking and attracting a pool of qualified candidates for a job vacancy’. Currently, the causes to the difficulties to recruitment and retention do not lead back to a questionable process. The federal and local governments are making efforts through funding and training initiatives, and compensation in regional towns is good.

The main themes in my findings are that working in regional practices does not appeal to younger doctors, and that current regional practitioners are over worked. Furthermore, Pollard (2007) adds that regional hospitals have to compete with metropolitan hospitals in the midst of the shortage, stating ‘the fight for scarce resources goes on’. This is also relevant on a macro level. Physicians for Human Rights (2007) describe the exodus of healthcare workers emigrating from poverty stricken African countries to richer Western countries for employment.

I believe that underlining the seeming ineffective recruitment and retention strategies, the issue appears to be a pure lack of doctors. On a positive note, incentives are now actively in place, and any action is better than none. 

Human Resource Planning: Forecasting Demand and Supply

Critical Analysis

Forecasting Demand
> An Ageing State
South Australia’s Health Care Plan 2007 – 2016 (2007), elaborates that Australia is an ageing nation with South Australia having the highest proportion of the aged, with one in six over 65 years old. It also notes that within the next 2 decades, that ratio will double, and accordingly, so will the proportion of chronic diseases. The South Australian Department of Health Annual Report 2005 – 2006 (2006) notes that there has been increases to emergency department attendances which ‘reflects an ageing population’.

> An Ageing Workforce
Williams (2007) aptly summarizes the South Australian medical workforce stating we have ‘1600 general practitioners registered in the state with an average age of 49.5 years. Specialists have a slightly higher average age of 51. More than 25 per cent of the state's population are boomers aged between 45 and 60 and by 2020 they will still account for more than 25 per cent of South Australia’s population, with most already retired’. According to the South Australian Public Sector Association (2006), by June 2011, the first of the baby boomers will turn 65 years old. This means that retirement is inevitable for most in the very near future.

Forecasting Supply
> Past Policies
Hawthorne & Birrell (2002, p. 60) discuss that in 1992, there was a perceived surplus of doctors in Australia and that this was fueled by increases in professional registrations secured by overseas trained doctors. The Australian Medical Workforce Advisory Committee (2000) note that consequently in 1995, policies were introduced to curb this surplus, which included reducing the number of medical school enrolments and limiting entrants to postgraduate training programs for general practitioners.

> Present Initiatives
From current media reviews, there has been particular focus on incentives aimed at increasing medical student opportunities in universities, thus increasing the eventual supply of doctors. For example, according to the South Australian Department of Health Annual Report 2005 – 2006 (2006), 30 additional medical student positions have been created in local universities and 60 nationally. However, Macnamara (2006) argues ‘the government has made going to university more difficult for domestic students by tightening up on access to student financial assistance and by increasing the cost of fees’.

Summary of key findings
Stone (2005, p. 65) states ‘an effective human resource planning process is essential to optimizing the utilization of an organisation’s human resources’. This involves being able to forecast supply and demand. Stone (2005, p. 47) further asserts that focusing on short-term needs is ineffective and reactive. The government’s approach has been quantitative, and forecasting demand has been simple. From statistics collaborated, projections have been made. Further healthcare strain is inevitable. It has proven difficult to forecast supply. Present initiatives have been heavily criticised as ineffective, and the reality of an ageing population and medical workforce coupled with the previously discussed acute shortage of doctors in Australia will result in further exacerbation.

Australia’s health is suffering as consequence of past policies, and the current diagnosis is fair at best. This human resource issue needs to be addressed, again, from a macro level. Seemingly, it is.

Strategic Human Resource Management: Questionable Allocations

Critical Analysis

Stone (2006, p. 13) states strategic human resource management involves an organisation’s capacity to ‘identify and analyse the threats and opportunities present in its external and internal environments’.  

> Budget Allocation
Owen (2007) proudly announced the state’s budget allocation towards the new Marjorie Jackson-Nelson Hospital project worth $1.7 billion highlighting that the project would be the most advanced in Australia. On the same note, South Australia’s Health Care Plan 2007 – 2016 (2007) proudly announced the following allocations:
•    Royal Adelaide Hospital: $15 million
•    Lyell McEwin Hospital: $202 million
•    Modbury Hospital: $12 million
•    Queen Elizabeth Hospital: $120 million
•    Flinders Medical Centre: $8.7 million
•    Noarlunga Hospital: $31.4 million
•    Ceduna Hospital: $36 million
•    Port Pirie Hospital: $12.5 million

The South Australia’s Health Care Plan 2007 – 2016 (2007) explains that most of the allocated investments will go toward upgrading present conditions and adding further specialist services. Additionally, the report shows that $215 million will be invested in upgrading the information technology systems across the public health system in South Australia.

As discussed earlier, South Australia is an ageing state, with ageing medical workers. The South Australia’s Health Care Plan 2007 – 2016 (2007) will essentially increase the current capacity for service provision, i.e. more beds for patients. It does not address the shortage of doctors, nor does it detail plans for further human resource development or recruitment and selection strategies. Day (2007) notes ‘the staff at all public hospitals are already working beyond their capacity and that's not a safe situation'. Similar concerns are voiced by Bildstien (2007) and Owen (2007).

> A global comparison
According to the World Health Organisation (2006), the continent of Africa suffers 24% of the global burden of disease but has only 3% of the health care workforce and 1% of the world's financial resources. Kumar (2007, p. 2565) discusses that, aside from poverty, a surfacing problem is that even though Africa has been blessed with generous global sponsors, effective distribution of medicines or vaccines is impossible due to the shortage of doctors.

Summary of key findings
Stone (2006, p. 31) explains that in this day and age, effectively managing human resources is essential. In this section, I focused my attention on the local government’s strategies for the future of this state. I found that South Australia’s health care plan seems more intent on capacity than on candidate.

Truly, Australia is facing the consequences of past policies. Unfortunately, the resulting shortage in doctors has been malignant, with effects spreading deep and wide. Perhaps if in 1992, the surplus of doctors could have been perceived through astute strategic human resource management, things would now be less critical. Anderson (2007) describes the current strategies aptly quoting Roxon ‘the federal government's had 11 years to fix this and, yet, here we are, 11 years on, with more than half of Australia in a state of crisis’.

Undeniably, coupling of progressive strategic human resource management and the implementation of effective preventative measures is paramount.