Prof. James Buchan’s Thoughts on Australia’s Health Workforce Issues, Dec 2010
Viewed from the bleak midwinter of the UK economic crisis, it is all too easy to see why Australia has been termed “the lucky country”.
A healthy economy and a growing population means an expanding health system. Australia is building new hospitals, is increasing the numbers of health professionals it trains, and continues to be active in international recruitment of doctors and nurses from other countries.
Factor in the massive recent strengthening in the purchasing power of the Australian dollar, and it is obvious why more doctors and nurses are leaving the UK for down under. And why the reverse flow from Australia to UK has plummeted. Five years ago, about two nurses moved from the UK to Australia for every one nurse travelling in the other direction. Now the ratio is more like five to one.
The main risk for Australia is that short term issues could distract from the longer term but obvious emerging demographic challenge- a bigger, older population making increasing demands on the health system. This carries with it two critical workforce risks.
Firstly, Australia could carry on with “more of the same”. It could train more and internationally recruit more doctors and nurses, rather than taking the opportunity of relative financial stability to create space for new roles and working practices to thrive. Better linkage between education providers and employers, underpinned by clear funding flows and incentives to do things differently can encourage “working differently” within the health sector. The effective use of technology to support e- medicine, and the introduction of evidence based new roles such as nurse practitioner will have to be supported by the new national regulatory authorities and government. It will also require some rural areas to be weaned off the default position that every country town deserves a doctor, and another doctor when the last one leaves, irrespective of the labour market and financial realities.
Secondly, Australia needs to take a cold look at its international recruitment practices. Long term heavy reliance on international recruits is an easy policy option that just might get a little tougher now that the WHO global code of practice on international recruitment has been approved. The Code sets a range of “ethical” principles and practices, including avoiding active recruitment from developing countries, and giving equal treatment, pay and career opportunities to international recruits. It also argues that developed countries need to invest more in becoming self sufficient, to lessen their reliance on the quick fix of international recruitment and take the pressure of the developing world.
The “ethics” of this argument may be subjective, and perhaps can be ignored. The secondary argument is less easy to duck. Long term over reliance on international recruitment can mask deeper health workforce problems, which require domestic solutions.
