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The aim of this report is to examine the current trends likely to influence the future of the medical practitioner workforce. The report focuses on the implications of the increase in the number of doctors and changes in workforce composition for several key areas: the extent and nature of competition in the medical sector; doctors' earnings; the role of the private sector; and technological change, data and information.

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Australia's health sector is grappling with challenges such as the ageing of the population and the growing burden of chronic disease. General Practitioners (GPs) are playing an increasingly crucial role given they are on the front lines of primary care, which accounts for more than 35 per cent of the health sector's total $162B expenditure. At the same time, however, there is less information available about the situation of and outlook for the GP sector. This report summarises the current context relating to GPs and analyses key trends in the GP sector. The report illuminates structural changes in the size and composition of the GP workforce, financial health of GP practices, job satisfaction and work-life balance amongst other trends and developments.

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Australia's more than 30,000 specialists (and 15,000 specialists-in-training) are at the heart of providing diagnostic and treatment services, restoring health and wellbeing across the country. Technology continues to transform the specialist sector, including innovations in diagnostics, medical devices, pharmaceuticals, surgical procedures, and digital technologies. These developments manifest themselves in less invasive and faster procedures, which are also less costly in the longer term, evidenced by the long-term growth in the proportion of day-only admissions and in private day hospitals. Yet there are significant pressures on both public and private healthcare providers, along with private health insurers, to provide more value to consumers, especially in the context of increasing health expenditures. The overall burden of disease is also growing as the population ages, especially chronic disease. This report uses the latest health sector data to analyse the trends and challenges facing medical specialists (excluding General Practitioners (GPs)). The report surveys trends and challenges in connection to the size and funding of the specialist sector and looks at issues around the drive for value, out-of-pocket payments and earnings, work–life balance and job satisfaction.

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Australia is currently experiencing a rapid growth in the number of medical graduates flowing into the workforce. The question is whether the increased number of pre-vocational trainees (interns) experience a reduced share of training opportunities and access to supervision, or whether the provision of training is keeping up with the growth in graduates. The aim of this project was to examine the impact of medical graduate expansion on the short term working patterns of doctors. As large numbers of interns begin to flow through the system, there are concerns about: the capacity of senior doctors to maintain the same level and quality of supervision and training; changes in the working patterns and job satisfaction of doctors involved in supervision and training; changes in the working patterns and job satisfaction of interns; and changes in the quality of the training received by interns. The study found that the growth in medical graduates was more pronounced in some states than others. It was able to group workforce data together for certain states and look for differences in the experiences of doctors in higher growth areas compared to low growth areas. The study presents data reported in the Medicine in Australia: Balancing Employment and Life (MABEL) survey by interns, registrars and senior doctors who provide supervision.

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The aim of this publication is to examine how labor and health economics can be used to analyse and better understand the role and functions of health worker labor markets. Health workforce shortages stem not only from inadequate overall supply, but also from suboptimal allocation of health human resources by location and role. Low performance and productivity are also issues. These three problems are often compounded by a resource problem - the gap between the finances required for an adequate workforce and those likely available. The application of labor economics to health care labor markets needs to account for the specific institutional features and market failures in health care.

The publication is organised as follows: the first section gives an introduction; the second section sets out a broad framework that needs to be used when examining health care labor markets; the third section summarises the key issues surrounding the demand and supply of health workers and how these interact in the health worker labor market; the fourth section summarises the broad analytical approaches used in economics, focusing on issues of causality and labor market dynamics; and the final section suggests some gaps in research and analysis for health worker labor markets in low- and middle-income countries (LMICs).

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Many countries face a continuing shortage in nurses' labour supply. Previous research suggests that nurses respond only weakly to changes in wages. However, the decision to exit or enter the nursing profession has not been taken into account in previous studies, although the occupational choice may be more responsive to wages than the labour supply decision at the intensive margin. We estimate a multi-sector model of nursing qualification holders' labour supply in different occupations. A structural approach allows us to model the labour force participation decision, the occupational and shift-type choice, and the decision about hours worked as a joint outcome following from maximizing a utility function. Disutility from work is allowed to vary by occupation and also by shift type in the utility function. Furthermore, we allow the preference parameters in the utility function to vary by certain family characteristics and personality. This may be important because the high incidence of shift work, potentially impeding the balance of work and family life, and the high level of emotional and personal involvement required in the profession suggest that the labour supply of nurses might depend on their personality and their family circumstances. Our results suggest that average wage elasticities might be higher than previous research has found. This is mainly due to the effect of wages on the decision to enter or exit the profession, which was not included in the previous literature, rather than from its effect on increased working hours for those who already work in the profession. We find that the negative labour supply elasticities with respect to income are higher for nurses with children, while the positive elasticities with respect to wages are higher for low-qualified, older and childless nurses. Elasticities do not appear to vary by personality trait.

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Using data from a new longitudinal survey of doctors from Australia, the authors test whether observed large gender-pay gaps among general practitioners (GPs) are the result of women's larger willingness to interrupt their careers. On average, female GPs earn [AUD] 83,000 or 54 per cent less than male GPs. The difference between men and women with children is [AUD] 105,000, and [AUD] 45,000 for men and women without children. Of this gap, 66-75 per cent is explained by differences in observable characteristics such as hours worked. The family gap emerges also within the sexes. Female GPs with children experience an earnings penalty of [AUD] 15,000-[AUD] 25,000 in comparison to women without children; almost 100 per cent of this difference is due to observable characteristics such as hours worked and career interruptions. Male GPs with children experience a family premium of [AUD] 35,000 in comparison to men without children, indicating the presence of a breadwinner effect that exacerbates the gender-earnings gap.

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This Evidence Check review examined factors influencing career choices of doctors. Three main groups of factors have been shown to be associated with career choice: the characteristics, skills, and abilities of medical students and graduates; the characteristics of undergraduate and postgraduate medical education and training; and the characteristics of alternative medical careers and jobs. Weak evidence suggested that unbiased career information from trusted supervisors, information on availability of specialist training places, and quality supervision may be effective in the early postgraduate years. The role of rural based clinical training needs to be further explored. There is an urgent need for high quality research on the influence of medical education, career information sources, and policies on specialty job characteristics on career choices.

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The National Health Workforce Planning and Research Collaboration (NHWPRC) was established by the former National Health Workforce Taskforce (NHWT) to undertake national health workforce research over a three-year period, including advice and development on future supply and demand models for the health workforce. This report discusses enhancements for forecasting methods as well as alternative methodologies for workforce planning, including different approaches to modelling demand. Alternative approaches explored in this study include: (1) competency-based planning, which is based on the tasks that 'should' be undertaken by specific health professionals and which they are competent and trained to provide, given the current and expected demands placed upon them; (2) needs-based approaches, which include the current approach of defining demand (need) based on utilisation of health expenditures, but also includes approaches using more direct measures of need using epidemiological or burden of disease data; (3) service-based planning, which specifies what types of health care services should be provided for a given level of demand or need, and then what type of workforce would be required to prove the specified services; and (4) economic approaches, which include the econometric estimation of demand and supply, including investigating the issue of attempting to control for the effect of supply on demand, and also modelling the expected additional costs and benefits of increasing the supply of health professionals. Show less

Background: The capacity for high-income countries to supply enough locally trained doctors to minimise their reliance on overseas-trained doctors (OTDs) is important for equitable global workforce distribution. However, the ability to achieve self-sufficiency of individual countries is poorly evaluated. This review draws on a decade of research evidence and applies additional stratified analyses from a unique longitudinal medical workforce research program (the Medicine in Australia: Balancing Employment and Life survey (MABEL)) to explore Australia's rural medical workforce self-sufficiency and inform rural workforce planning. Australia is a country with a strong medical education system and extensive rural workforce policies, including a requirement that newly arrived OTDs work up to 10 years in underserved, mostly rural, communities to access reimbursement for clinical services through Australia's universal health insurance scheme, called Medicare.

Findings: Despite increases in the number of Australian-trained doctors, more than doubling since the late 1990s, recent locally trained graduates are less likely to work either as general practitioners (GPs) or in rural communities compared to local graduates of the 1970s-1980s. The proportion of OTDs among rural GPs and other medical specialists increases for each cohort of doctors entering the medical workforce since the 1970, peaking for entrants in 2005-2009. Rural self-sufficiency will be enhanced with policies of selecting rural-origin students, increasing the balance of generalist doctors, enhancing opportunities for remaining in rural areas for training, ensuring sustainable rural working conditions and using innovative service models. However, these policies need to be strongly integrated across the long medical workforce training pathway for successful rural workforce supply and distribution outcomes by locally trained doctors. Meanwhile, OTDs substantially continue to underpin Australia's rural medical service capacity. The training pathways and social support for OTDs in rural areas is critical given their ongoing contribution to Australia's rural medical workforce. Conclusion: It is essential for Australia to monitor its ongoing reliance on OTDs in rural areas and be considerate of the potential impact on global workforce distribution.

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