Health Workforce Design for the 21st Century
Duckett, Stephen J., Australian Health Review
The Australian health workforce has changed dramatically over the last 4 years, growing in size and changing composition. However, more changes will be needed in the future to respond to the epidemiological and demographic transition of the Australian population. A critical issue will be whether the supply of health professionals will keep pace with demand. There are current recorded shortages of most health professionals, but this paper argues that future workforce planning should not be based on providing more of the same. Rather, the roles of health professionals will need to change and workforce planning needs to place a stronger emphasis on issues of workforce substitution, that is, a different mix of responsibilities. This will also require changes in educational preparation, in particular an increased emphasis on interprofessional work and common foundation learning.
Aust Health Rev 2005: 29(2): 201-210
THE CURRENT STRUCTURE of the Australian health care workforce represents the logical outworkings of a process of professionalisation which commenced in the late 19th century and was consolidated by the mid 20th century. This process was characterised by a struggle for autonomy from the medical profession by other occupational groups,1 an increased scientific base for training programs, and a consequent move to university and degree status for preparation for most of the health professions.
There have been dramatic changes in health care since the occupational structure of the workforce was consolidated, including changes in payment mechanisms, the incidence and treatment of diseases and in the organisation of health care. Incremental change in the educational preparation of health care workers is probably no longer an appropriate response to the major challenges facing the health system and its workforce. This paper outlines a new approach for preparing the health workforce.
The Australian health workforce today
The health sector in Australia accounts for 6.7% of the employed workforce, smaller than the health share of gross domestic product. Health professionals account for 43% of employment in the health industry (other groups include managers, cleaners, social welfare professionals, people in trades, and so on). Nurses comprise the single largest health profession, accounting for just over one-quarter of all health industry employment. The health workforce is predominantly female (77.4%), although the higher income professions tend to be male dominated: 79% of specialist medical practitioners are male; males make up 59% of generalist medical practitioners, compared with 8% of registered nurses and 18% of physiotherapists.2
The health workforce has grown substantially over the last 40 years. The 1961 census, for example, recorded a total 72 598 health professionals (that is, people with health professional qualifications, whether employed or not), 56% of whom were registered nurses, 16% medical practitioners, and the remaining 28% all other health professionals. By 2001, the health workforce had quadrupled to 291 604 with nurses now accounting for 59%, medical practitioners 17%, and others 24%. The number of health professionals per head of population increased from 6.9 per 1000 population in 1961 to 15.4 per 1000 population in 2001.2
The health workforce is now characterised by a large number of separate professions, each with a different course of preparation, a different emphasis in practice and, to some extent, a different ideological foundation in terms of the way in which the profession interacts with other professions and with patients or consumers. The workforce has changed dramatically over the last 20 years with increasing specialisation both within professions (for example, additional specialisations in medicine and nursing) and also by the creation of new professions. To some extent, this specialisation has led to increased quality of care as individual professionals have been able to develop in-depth knowledge and skills across a narrower range of areas. …