This issue of MJA Open is about the role that doctors will play in the health system of the future, where and how they might work, how we might train them and how are we going to fund them.

The health and social welfare sector is now the largest workforce in Australia (1.4 million), not to mention the 2.3 million carers (both paid and unpaid) who provide support every day for those Australians who for many reasons cannot take care of themselves. This workforce is, like the rest of the population, ageing and wanting to work in different ways. What we can do for patients has changed so much over the past 20 years that it often bears little relation to what health professionals were taught at university — and this change is likely to continue into the future at an even more rapid pace. The importance of the health workforce is no better emphasised than by the Australian federal and state governments’ commitment to establish Health Workforce Australia in 2009 with triennial funding of $1.4 billion. This organisation has as its mission creating a more sustainable health workforce by 2025 (https://www.hwa.gov.au).

New knowledge and technology are great drivers of change in medicine, as in other disciplines. The increase in genetic testing in the past 10 years alone has been responsible for a major shift in diagnosis, treatment and prevention of many diseases. New imaging techniques have allowed diagnosis of conditions at a much earlier and often more easily treatable stage, such that diseases that killed 30 years ago (many forms of cancer, some metabolic disorders) are now curable, or patients can maintain a good quality of life with continuing therapy. There is little doubt it will be chronic diseases and dementia that will shape the challenge of delivering health services in the foreseeable future.1

These and other developments have prompted much discussion and review within the medical and broader health professions, in the community, and particularly within medical schools, where we are preparing young people for careers that will run for 40 or more years. One of the major challenges for educators and health professionals is accepting that health care is now delivered as a team activity by various health professionals; and one of the most important issues for health professional education is embedding those team care skills through various interprofessional learning experiences.2 That said, given the pivotal role that doctors play in health care, this MJA Open will concentrate on the role that doctors play in the health workforce.

The questions we face as we develop curricula, prepare exams, run tutorials and teach clinical skills are complex. It is easy enough to say that change will occur, but narrowing down the specifics of what and where — and preparing for such a future — provides a challenge of a different magnitude altogether. For example, how will we cope with clinical training demands from the increasing number of medical students, when patients in hospitals are now often unable to be as involved in teaching programs as they were a decade or two ago, because of the nature of their condition or the short period of their stay in hospital? What are the opportunities for clinical learning in private hospitals, in aged care and mental health facilities and in primary care? How can we effectively use the wonderful clinical experiences that abound outside the traditional tertiary teaching hospitals in primary care, aged care facilities, mental health services and in the community? All medical schools have embraced the need to increase clinical training opportunities to some extent through rural clinical school initiatives, by which students spend the bulk of their clinical training in the rural sector and achieve equivalent examination results to those trained in city hospitals. It should be acknowledged, however, that some schools have done better than others in this regard.3

So how different do we believe the practice of medicine will really be in the future? What tasks will doctors still need to do? What will patients want from us? How much of our daily routine will be performed by other health professionals? What role will IT (information technology) play in practice? Will consultations all take place remotely? Certainly, telemedicine is changing the way we deliver health services, but it has taken us over a decade from the emergence of data showing that it could work to reach the point where we actually have an item number allowing doctors to charge for this service.

More fundamentally, can we anticipate what changes are likely and prepare students accordingly? And how much of our focus should be on developing the skills to learn, to discover, to evaluate new knowledge as it becomes available and to understand change management? In this rapidly changing environment, perhaps we need to revisit our fairly recent focus on specialism and train more generalist health professionals who have greater flexibility to change career track as the environment around them changes.

A fundamental interaction between patient and doctor is the consultation or the procedure, and this may change little. Doctors have been taking histories and examining people for millennia. The nuances of communication and the time-honoured physical examination skills will still require personal contact between patient and provider, although significant amounts of this interaction may develop a “virtuality”. The task of gathering and evaluating data through patient history-taking, physical examination and diagnostic testing to form a differential diagnosis, which is then tested and challenged until the diagnosis is confirmed, will not change. It will, however, be significantly enhanced by such things as an electronic health record owned by the patient and shared between professionals. This will surely rid us of much duplication of effort as patients move across the health system.

Some consultations may take place virtually, particularly among patients with chronic disease who need following up and people living in distant locations. It is also possible for people with diabetes to have their weight, exercise, blood glucose and HbA1c all monitored via a mobile phone, and for communication with the doctor or other health professional to take place by phone or as a telehealth consultation. As health professionals, we often do not appreciate the time taken for both patients and professionals to travel between appointments. Yet, there is a need to quickly explore and evaluate such new models of health care delivery.

The attributes we look for in admitting students to our medical program — compassion, understanding, empathy, a sense of ethics — and the skills of problem solving, listening and communication will be critical in health professionals far into the future.4 Advances in biology and IT will never overshadow them.

Other aspects of medical practice, similarly, will change little over the next decades. Most of the sickest patients will continue to be treated in hospital, where doctors will increasingly be focused on resolving acute exacerbation of chronic health issues, treating life-threatening conditions such as cancer and managing severe trauma. Most of the medical profession’s work will continue to occur in community settings, whether in general or specialist practice, but there will be a need to shift our focus to out-of-hospital care models, as well as to get serious about disease prevention.5

Predictions even a decade ahead in a field such as medical workforce necessarily involve qualification. Having said that, we can be reasonably confident that the recent drivers of change — which have already altered the practice of medicine to varying degrees — will continue to be a factor into the foreseeable future. They will challenge experienced practitioners and young graduates alike. Issues such as the feminisation of the workforce, work–life balance, and safe hours clauses have had significant influences on training and on how we manage the workforce. Should we continue to rely on overseas-trained doctors, from countries who often need them much more than we do, to support our workforce — particularly in rural areas? The rapidly increasing costs of health care will also play a major role in stimulating new ways of approaching health care delivery. An uncapped fee-for-service system that encourages activity rather than rational care is unlikely to escape the eye of government funding circles for very much longer.

More than anything else, the way doctors operate in the future will be influenced by advances in IT, biology, pathology and therapy.

Every year, we will have new graphic insights into anatomical nooks and crannies and physiological or pathological functions in molecules that at the moment we may not even know exist. Tracking of metastatic cells, visualisation of oxygen-starved tissues and toxin-poisoned cells will be routine. Tumours will be phenotyped in far greater detail than at present. Patterns of expression of proteins in cancers and detection of minute quantities of these proteins in blood will change diagnosis, prognostication and our ability to tailor treatments to individual patients and their tumours. Drug sensitivities, toxicities and methods of administration will be refined. The therapeutic armamentarium will be expanded to include inhibitors and modifications of molecules yet to be identified. We may not yet have a complete understanding of the interaction between all the proteins expressed by our 25 000 genes or between each of the two copies of our genes, but we will know our basic gene sequence. Advances in stem-cell therapies, bioengineering and nanotechnology will provide exciting opportunities both diagnostically and therapeutically.

But if advances in biology and improvements in pathology and imaging give us the potential for faster and more accurate diagnoses of diseases, doctors will be required to upgrade their skills or learn new skills.

More than ever before, they will need to be able to sort the wood from the trees. Collecting, critiquing, and interpreting the vast amounts of new information will be an increasingly important skill of future practitioners. Doctors will need high-order abilities in data management. Much of the information will be biological, so doctors will also need a thorough understanding of what is normal to recognise what is not so normal.

Research training, by which students and graduates become experienced in critical thinking and interpretation of new knowledge as it becomes available, will become increasingly important. There will be a need to encourage interdisciplinary research, encompassing engineering nanotechnology and IT, and to look for ways of appropriately funding this research. There is also a need for research on educational methods such as simulation, on health systems research and on how to implement new knowledge.

In all this, the roles of patient and doctor are likely to change. Doctors will not be the all-authoritative figure but part of, or the leader of, a team of professionals providing a range of care in an integrated, evidenced-based way. Leadership skills will be required by some and “followership” skills by all.

Managing health resources in an era of longer lives, high technology, increased expectations and rising incidence of chronic disease will be one of the key challenges for governments, communities and the medical profession.

In the decades ahead, resource allocation will need to change from acute care to preventive care. The changes will need to be supported by evidence, and will need to result in greater resources for prevention. Vaccinating young women and men against papilloma virus, for example, will save many lives and much morbidity and reduce the high cost of treating cervical cancer.

Resource allocation will be guided by engaged community discussions on subjects such as the need for advance health care directives, issues surrounding the right of access to high technology, high-cost end-of-life care, allocation of resources to people with disability, consumers’ responsibility for self-care, and roles and responsibilities of families in providing care. Ideally, resource allocation will be without political or professional self-interest, and will balance the best interests of the individual against those of the population.

Doctors will need to be fully involved in critical decisions on resource allocation, but to fully participate they will need to be informed by research and able to take responsibility for the active enquiry which informs policies and decisions.

Doctors should be the key advocates for our health system and our patients. Hopefully, by 2025, we will have long moved on from the current cost-shifting between state and federal governments; but the risk of bureaucratic armies or ill informed decisions that result in funds being diverted to meet political or other objectives rather than spent on health care will always be there.

It is almost certain that patients, even a decade ahead, will be different. Immigration patterns are already changing Australia’s population, and medicine is increasingly a profession where people have the opportunity to (and do) work in all corners of the globe.

Disease patterns will likely be different. If the global epidemic of obesity is unchecked, people with diabetes, blindness, renal failure, stroke, myocardial and peripheral ischaemia and arthritis will overwhelm our hospitals. Infectious diseases will change if global warming continues; dengue and many other arthropod-borne diseases will occur in temperate climates. People will be more mobile, and diseases seen infrequently in Australia will likely become more prevalent.

Doctors of the future will need to have a broad understanding of the scope of medical practice in Australia and internationally. Their training and experience will have given them experience in the public and private health systems, and in metropolitan and rural and remote Australia.

Understanding of the needs of patients in these different settings and areas will enable better allocation of resources and the provision of better care. This is more a wish than a prediction, but we believe that if all doctors spend a period of time — either during medical school training or after — in a resource-poor health care setting in a developing country, it would provide them with insight and experience of advanced pathology and the scale of international suffering and health inequity.

As educators, our role is to try to anticipate these changes and prepare our graduates with the skills to drive change and thrive on uncertainty. These skills include not only research training and lifelong learning, but the management and leadership skills to predict and forge the changes that will inevitably occur in their own practising lives.

For this MJA Open, we have asked authors to be provocative and challenge the status quo and to project their area of expertise into the future and see how the medical workforce will sit within the health system in 2025. This must be from the perspective of how we fund health care, who will be working in it, international migration of health workers, and how we get doctors to work in rural areas and with disadvantaged populations. We are sure there are areas we have not covered, but we hope this publication will stimulate your contributions to medical workforce solutions.

Medical workforce supply levels follow a predictable, if lengthy, cycle between phases of shortage and surplus. In Australia we are currently in an upswing stage; there has been significant growth in Australian medical workforce supply in the past decade. Between 1999 and 2009, there was an increase of over 20 000 employed medical practitioners — from around 50 000 to almost 73 000.1 Recent expansion of medical training programs does not largely account for this increase, as graduates of these programs only began entering the workforce in 2006, with the majority entering after 2008.2

While such observed increases may reduce concerns about workforce shortages at the global level, they occur in the context of increasing demand for services at rates beyond population growth. In this article, I review current trends in medical workforce supply levels, identify key policy challenges arising from them and discuss how these might be met to ensure an adequate and sustainable workforce into the future. Emerging workforce policy challenges associated with current trends include reduced participation levels in the workforce and “bottleneck” issues for young doctors trying to enter specialist training programs. Distribution also continues to be a problem despite overall increases in the medical workforce, with imbalances across geographic regions and between specialties.

The decreasing participation levels of doctors can be seen in a decline in average working hours. In 1999, Australian doctors worked 45.6 hours per week on average. By 2009, this had decreased to 42.2 hours per week.1 This translates to more than 6000 fewer full-time equivalent doctors than would be the case if average working hours in 2009 were the same as those a decade earlier. This decreasing work effort is attributable to an increased proportion of women in the medical workforce, a changing age profile, and changing work–life balance expectations.

Women comprised 36% of the medical workforce in 2009, up from 29% in 1999.1 Women account for only 19% of doctors aged 55 years and over (who as a group represent 25% of the total workforce), compared with almost 50% of doctors aged 35 years and under. The ratio of women to men in the medical workforce is likely to eventually reach 1 : 1, but currently, significant disparities between subgroups remain. While women comprise 39% of the general practice workforce, they comprise only 25% of the specialist workforce. Female doctors, on average, work fewer hours than male doctors (37.5 hours per week compared with 44.9); however, sex differences are less apparent for younger doctors. Female doctors under the age of 35 years work only 2 hours per week less than male doctors. For those aged 25–34 years, the averages are about 44 hours per week (women) and 46 hours per week (men); and for those under the age of 25 years, the corresponding figures are about 46 and 48 hours per week, respectively.1

While the average age of members of the medical workforce did not change between 1998 and 2008, there was nevertheless a changed age distribution during this period. In 2008, there was a higher proportion of doctors aged 55–64 years than in 1998, and a lower proportion aged 35–44 years. This reflects a sizeable group of medical practitioners who entered the Australian medical workforce in the previous “boom” phase in the 1970s. The “demographic hump” created by this group has been steadily moving through the age range and is now approaching traditional retirement age. Doctors who remain in the workforce beyond 65 years of age work far fewer hours than younger doctors. Hence, the coming years will see a considerable number of doctors either retiring altogether or reducing their working hours as they approach retirement. Retirement trends are a major influence on overall workforce supply levels,3 but there is relatively little information currently available on actual retirement patterns. Studies of retirement intentions suggest that one-third of general practitioners plan to retire before turning 65, and that job satisfaction is a key factor in this decision.4 Recent changes to registration arrangements, implemented as part of the move to the national registration scheme, made it more difficult for doctors to “step down” their clinical practice, by removing categories of registration that allowed some continued clinical practice without the requirements of full registration in relation to professional development and indemnity insurance.5 Proposals to remedy this, to ensure that a stepped approach is still a viable option for doctors, were the subject of a campaign driven by the profession.6

Work–life balance issues are increasingly prominent in the minds of doctors of all ages but have been particularly noted among younger doctors.7,8 Hospital non-specialists (a group largely comprising doctors in their early postgraduate years) overall worked fewer hours per week in 2009 than a decade earlier.1 Male hospital non-specialists have reduced their working hours while women have actually marginally increased theirs, so that the difference between the two sexes is now less than before.1 Overall, male doctors have made greater reductions than females to their working hours over the last decade, thus reducing the overall gender gap.1 Choice of specialty is influenced by the perceived work–life balance afforded by a specialty,9,10 and by hours of work and the possibility of time out from the medical workforce.

The early postgraduate years are a critical time for doctors, when job demands are likely to be high and when many are making decisions about which specialty they wish to practise in for the rest of their working lives.7,10

Since 2000, graduate numbers have doubled; from around 1400 a year to 2733 in 2010. They are projected to increase further, to reach almost 4000 in 2016.11 The number of intern places has been slightly higher (by 5%–10%) than the number of graduates the previous year (Box 1), partly because of New Zealand graduates and other international medical graduates coming into the system (via the Australian Medical Council pathway). The figure also indicates how this gap closed in 2009 and 2010. On the basis of projected numbers of Australian medical graduates, we can anticipate that intern places will need to increase by over 1000 in the next 5 years. Difficulties are already being experienced in attaining sufficient settings and supervisors,12 and these seem likely to continue, or worsen, in the next few years. A broader and more flexible approach to internships is likely to be required to accommodate the growing numbers (eg, incorporating private sector and primary care settings as well as traditional large public hospitals). Achieving this successfully will require cross-sectoral collaboration to ensure comparability of training experiences and appropriate resourcing across settings.13

Typically, medical graduates remain in general postgraduate positions for an additional 1–3 years before entering vocational training programs. Because the timing of entry to these programs varies relative to graduation, it is difficult to estimate the progression of successive cohorts of graduates into this stage.

However, data are available on the number of basic, advanced and total trainees (Box 2). These data indicate relatively little change between 2000 and 2003, followed by significant growth in overall trainee numbers since 2004. Advanced trainee numbers increased 80% between 2001 and 2011, with most of the increase occurring since 2005. Increases have been somewhat uneven across specialties during this period (Box 3). A number of specialties more than doubled their number of trainees, and all clinical patient-care specialties have had some growth. Five new training programs were in operation in 2011 that did not exist a decade earlier. The largest absolute increases in trainee numbers were in general practice (increase of 1429) and adult medicine (increase of 1029). As with internships, a more diverse array of training arrangements is likely to be required for vocational training, with concomitant challenges in maintaining equivalence.

Policy debates are already starting to come full circle, with concerns now being raised about potential oversupply in the medical workforce.14 This mirrors the pattern seen in previous decades, with the 1970s boom (in response to perceived shortages) followed by perceived surpluses through the 1980s and 1990s, which in turn influenced restrictive policies on entry to the medical workforce. To some extent, such swings in perception may be inevitable. To avoid the extremes, it is important to maintain a proactive approach to workforce policy that is informed by good evidence and takes into account both macro-level total supply trends and issues in specific sectors or specialties. For example, workforce supply in non-metropolitan areas remains below levels in major cities.15 Shortages are also apparent in specialties, including orthopaedic surgery, ear, nose and throat surgery, obstetrics, pathology, radiology, oncology, psychiatry and general medicine.16,17 Within the primary care sector, specific services are problematic, such as after-hours services, home visits, and procedural GP services in rural areas. Current programs have invested significant funds to try to redress the shortage of after-hours services and procedural rural GPs, but significant problems remain.18

Looking forward to 2025, there are a number of clear directions to pursue in order to ensure a medical workforce that is both adequate for the task of meeting the medical care needs of the Australian community, and is sustainable for the long term:

• Ensuring an adequate workforce in the primary health care sector and rural regions.

• Developing and maintaining capacity to identify and respond to ongoing and emerging health workforce policy challenges.

• Accommodating diverse patterns of workforce participation.

The primary health care workforce must remain a priority in order to cope with likely increases in demand associated with an ageing population, increasing prevalence of chronic disease, and a greater emphasis on risk factor management and health promotion. The primary health care workforce of the future is increasingly likely to be a multidisciplinary team, and planning for the future GP workforce needs to take this into account with respect to both the overall numbers and the skills and expertise required.

While the increases already seen in the general practice pipeline are encouraging, additional strategies for increasing participation include promotion of the attractions of general practice as a specialty, including the potential for good work–life balance, flexibility in the training program, and high job satisfaction.19 Exposure during training to positive experiences of general practice may promote uptake of GP careers among medical graduates. Given the importance of relative pay rates for doctors in their choice of specialty,20 increasing GP pay is another potential strategy to support recruitment. However, non-financial incentives (such as controllable hours, flexibility and opportunities for “interesting” work) are also important.20

An adequate rural medical workforce is also likely to be multidisciplinary in nature, and should be supported by best possible use of information and communications technology. Current funding mechanisms do not cover implementing recent technologies (including phone, email and videolink) that have the potential to allow doctors to communicate with patients remotely in a safe and effective way. The introduction of Medicare rebates for video consultations with specialists is a welcome step in aligning funding mechanisms with modern communications technologies. However, numerous other options that allow doctors to communicate with patients or with other health professionals at a distance (such as email, remote monitoring by phone or internet, or remote review of images) are yet to be incorporated into standard funding and service models.

The establishment of Health Workforce Australia (HWA) is an important milestone in the development of national capacity for workforce planning and policy. HWA has a key role to play in identifying and responding to specific shortages while also monitoring the big picture of workforce supply and demand, to minimise as far as possible the boom–bust cycle. Monitoring of shortages in specific specialties was undertaken in a detailed fashion by the Australian Medical Workforce Advisory Committee during its tenure from 1996 to 2006, but more recently attention has shifted to big picture issues and reform. Both levels must be attended to for effective workforce planning and policy.

HWA needs to build its capacity to collect and analyse data and to communicate to policy decisionmakers the important trends and patterns indicated. Workforce policy needs to be informed not just by the “profile” characteristics kept in HWA datasets, but by information explaining individual decision making — why doctors are making the choices they are, and what potential there is to influence those choices with policy levers.

The changed expectations and preferences of doctors with regard to working hours and participation will need to be matched by a range of strategies to accommodate such preferences, to prevent even greater losses of work effort over the career span. This may include more flexible leave and part-time arrangements in employment and training, as well as facilitation of re-entry to the medical workforce. It has been suggested that doctors approaching retirement could be engaged in medical education,21 a strategy which has the potential to retain older doctors and increase their job satisfaction, while also meeting the educational needs of younger doctors. Significant gaps remain in an understanding of factors influencing doctors’ choices about workforce participation during the late career, pre-retirement stage. Such information is of crucial importance in maintaining the attachment of these doctors to the workforce.

Innovative care models are likely to be required to meet demand for after-hours care. Many new approaches are already in place, such as call centres and help lines, GP clinics co-located with emergency departments, nurse triage services and so on. Such strategies should be expanded and further developed. Many of these alternatives incorporate an element of skill-mix changes, and further innovation in scope of practice for non-medical health professionals (including new roles such as physician assistants and nurse practitioners) has the potential to significantly alter future medical workforce requirements.22

In contrast to the traditional focus of medical workforce policy and planning on the supply pipeline, the future will be more about influencing the decision making of doctors currently in the workforce in relation to working hours, location of practice, specialty field and workforce participation. This is particularly so for doctors in the early stages of their career, who are making decisions about specialty disciplines and working styles, and for doctors at the other end of their career, who are approaching retirement. Key determinants operate at the systemic level, such as availability of training places and financial factors, and at the individual level, such as professional support, working hours, job satisfaction and the flexibility or predictability of work. Understanding these determinants is of critical importance for effective medical workforce policy in the future.

1 Numbers of Australian medical graduates (domestic and total), and number of intern places*

* Actual numbers shown up to 2010, and projected numbers of graduates for 2011–2016.11 Numbers of intern places are shown lagged by 1 year to display the relationship to the number of graduates in the previous year (eg, data shown for internships for 2003 is number of internships in 2004, which are largely taken up by 2003 graduates).

2 Vocational trainees: basic, advanced and total trainee numbers, 2000–2011*11

* Some colleges report number of trainees while others report number of accredited positions.

National health workforce planning is not a new concept. In 1995, the Australian Medical Workforce Advisory Committee (AMWAC) was established under the Australian Health Ministers’ Advisory Council (AHMAC) to “assist with the development of a more strategic focus on medical workforce planning in Australia”.1 In 2000, the Australian Health Workforce Advisory Committee (AHWAC) was established by AHMAC to oversee national-level, government-initiated health workforce planning in Australia, covering the nursing, midwifery and allied health workforces. Following a review of AHMAC workforce committees, AMWAC and AHWAC ceased operating in June 2006; however, at the same time, the Council of Australian Governments (COAG) agreed to a significant national health workforce reform package which included the establishment of the National Health Workforce Taskforce (NHWT). The NHWT was a time-limited entity created to develop strategies to meet the National Health Workforce Strategic Framework outcomes.

Each of these organisations carried out national health workforce planning. The importance of national workforce planning is recognised, given the challenges Australia is facing to its health workforce now and into the future. Such challenges are well documented2,3 and include an ageing population; expected increased demand for health services and increasing expectations for service delivery; changing burden of disease; and broader labour market issues. The national health reform agenda also reinforces the importance of national workforce planning. The majority of health expenditure relates to the health workforce,4,5 so any system reform subsequently has an impact on workforce. For example, many recent reforms have focused on the delivery of primary health care — the introduction of Medicare Locals, GP Superclinics and support for new roles such as nurse practitioners through enabling access to the Medicare Benefits Schedule — all of which will affect the primary care health workforce. The importance of national workforce planning was also reinforced by the National Health and Hospitals Reform Commission, which noted in 2009,

In 2008, COAG agreed to the National Partnership Agreement on Hospital and Health Workforce Reform, which acknowledged that a national, coordinated approach to health workforce reform with a particular focus on linking efforts of health and higher education sectors was necessary. Subsequently, Health Workforce Australia (HWA) was established as the national agency to progress health workforce reform in Australia and address the challenges of providing a skilled, innovative and flexible health workforce. HWA is a Commonwealth statutory authority, the HWA Board is its governing body, and HWA reports to the Standing Council on Health (SCoH, previously the Australian Health Ministers’ Conference).

The Australian Health Ministers’ Conference commissioned HWA to undertake a workforce planning exercise for doctors, nurses and midwives over a planning horizon to 2025. This project was to present (and measure) possible future health workforce outcomes and training implications under a range of workforce planning scenarios. It was initially known as the National Training Plan; however, in recognition of the fact the planning scenarios identify a range of future health workforce outcomes arising from various potential policy options, of which training is only one, the report has been renamed Health Workforce 2025 — Doctors, Nurses and Midwives (HW 2025). HW 2025 was conducted in two phases. Phase 1 developed projections for the size and type of the health workforce (doctors, nurses and midwives) needed to meet future service requirements from 2012 to 2025 under a range of alternative “futures”, including:

• moving to self-sufficiency (demonstrated by modelling reducing overseas migration);

• productivity gains over the projection period;

• capped working hours for doctors; and

• changing nursing retention rates.

Phase 2 modelled the training pipeline necessary to meet the size and type of the health workforce identified in phase 1. That is, it provides the estimated numbers of professional entry students, graduates and trainees (for doctors) required between 2012 and 2025 to achieve a workforce in balance at the end of the planning period. Results of HW 2025 were presented to the Australian Health Ministers through the SCoH in April 2012.

In developing HW 2025, HWA followed a number of key principles to ensure the projections are robust, realistic, sophisticated and able to be applied nationally.

One of the key principles underpinning HW 2025 is that it will be an ongoing process in which projections will be continually improved. There are several factors that will be pursued with the aim of improving HW 2025 projections.

There is an ongoing need for health workforce planning to meet the challenges the Australian health workforce is facing now and in the future. Health workforce projections provide a tool to enable planning by highlighting areas of potential workforce imbalance that may call for government intervention or reform. While health workforce projections have been generated at national and state and territory levels previously, this was often done using different datasets, assumptions and methodologies, making it difficult to provide a nationally coherent view of the future health workforce. Through HW 2025, HWA is developing a set of nationally authoritative, consistent and coherent health workforce projections that can be used for health workforce planning. In particular, the iterative nature of HW 2025 provides a means for planners to monitor the impact of incremental adjustments to the health workforce, taking account of significant changes in the health system or underlying social and economic environment.