Clinician shortages abound. Ageing, chronic disease and rising patient expectations are chewing through any latent capacity within health systems around the world at the same time as the baby boomer participants in those workforces ease into retirement. Everywhere health groups are talking about shortages of people. let alone good people!
How do we overcome this? The recent proposal to create another medical school in Western Australia was hardly well received by a system groaning under the weight of demand. Others would say that even as we increase training capacity we perhaps lower the quality of graduates. So at many levels this solution has problems.
Data released a week ago on workforce modelling in Australia indicates that nursing schools have a 34% attrition rate. We are also expected to have a shortfall in nurses of 85,000 by 2025. Medical schools are lucky to have a single figure attrition rate, perhaps because so many courses are post-graduate entry. Either way, what is clear is that once qualified, very many of our investments do not find their way to patients over the long-term. The challenges confronted by clinicians means they leave patient facing activity in droves and often the entire sector. This is not good news for a system experiencing huge growth. Even with the considerable positive differential between Australian remuneration (most especially for GPs) and overseas, poaching is not a sustainable solution.
Many regions are taking a different approach to the problem. They are deliberately fostering a multi-disciplinary approach. This equates to bringing in complementary skills from the social sciences, allied health, nursing and medicine with a good dose of systems and administration to pull it all together. Work is spread across the team to the maximum scope of practice of all players. In most sites, reported improvements in patient outcomes results in vastly improved satisfaction for patients and those involved in care.
The biggest driver of satisfaction seems to be threefold; not working in isolation and feeling like you offer insufficient support to solve real problems, having other specialists to turn to for input and creating a career path. The leading systems are fostering specialisation by doctors and nurses!
Doctors are running complex care for diabetes, dermatology, hepatitis and a myriad of other conditions which are both in demand and of interest to the clinician. Their standing as the resident “expert” in a domain does not preclude them from doing generalist work if they choose too. It simply means that for some sessions or some types of patients they are the acknowledged expert. Increasingly, these folks are being called upon to support their own patients, have input into their colleagues patients and perhaps even be the hub within a network of general practice providers. With more training, more time to see these complex patients and better systems and models of care to support the work, the entire effort has multiple dividends.
Maybe rather than more clinicians, what we need is better and deeper care using our existing resources in new configurations which support individual aspiration and interest as well as real patient need. If we do this well, clinicians with corresponding objectives will seek our centres out to the benefit of our patients and our team.
Tracey Johnson, General Manager, Inala Primary Care