Peter Brooks: Are we training too many doctors?

AUSTRALIA has one of the best health care systems in the world, particularly from the perspective of quality of care and access to services. It is, however, under increasing stress to cope with the ageing population, chronic disease and unrealistic demands.

Predictions are that the health budget will consume nearly 20% of gross domestic product by 2025. Health is the largest sector of the Australian workforce, with about 1.4 million workers in health and social services.

Given the human resource-intensive nature of this sector, we will probably need to recruit about half a million workers into health and social welfare in the next decade if we are to maintain the existing standard of community services.

So, it is against this background that we need to ask the question: are we training too many doctors? And, can we afford them?

You have to take into account that we have an interesting way of paying doctors in this country — an uncapped (no limit) fee-for-service system that rewards doing things (a procedure) rather than making a diagnosis (taking a history and performing what is still one of the best “investigations” in medicine, a full physical examination). This tends to reward the specialists.

• To properly answer the question on doctor numbers we first need to know:
  What health services we want to provide in 2020
  Who might deliver those services
  Where they will be delivered
  How to ensure adequate training of those delivering these services
  Who is going to pay for them

These issues raise the further question of whether other health professionals (nurses, carers, pharmacists, physiotherapists, physician assistants) could be trained to do some of the tasks currently carried out by doctors.

Certainly, any role expansion by these health workers must not compromise patient care but this sort of activity already occurs in many other countries. For example, nurse endoscopists and nurse anaesthetists work closely with the relevant specialists in the United Kingdom and United States to expand the services that can be provided for patients without changing patient outcomes.

Team care is what the future of health care is all about — learning to work in teams with shared responsibilities, good coordination and excellent communication across those teams.

No one in health care can really claim to work as an independent practitioner in 2011; we work as teams.

The use of technology (mobile devices, teleconferencing) will allow these teams to communicate distantly with each other and with patients, and thus provide access to health services that are currently only available in major centres across this broad wide land .

Telemedicine rebates are due to be initiated in July at last, and this could influence our requirements for doctors significantly.

A recent book, 2030 — The future of medicine, presents compelling arguments for engaging the community in their health care using new communication platforms and ensuring that doctors and health professionals in general keep patients out of hospital.

“Head in the clouds,” you say?

Yes, that is exactly where we must be — in the information “cloud”. If we increased the average health literacy of Australians by 20%, imagine what that might mean to health worker predictions, including the number of doctors needed,  and the health of the community.

A community that takes responsibility for its health? Don’t dream; help to make it happen.

Professor Peter Brooks is the director of the Australian Health Workforce Institute at the University of Melbourne.

Professor Brooks will be one of the speakers at a seminar titled “Are we training too many doctors?” in Sydney on 3 May as part of the University of Sydney Controversies and Leadership in Health Seminars.

Posted 18 April 2011