Career Development in a Changing Health Service (Delivery) Environment

1. Career Development in a Changing Health Service (Delivery) Environment Simon M Willcock HETI NSW Prevocational Forum August 9th, 2012

2. Medical Careers – is there a Problem? Continuum of Medical Education Postgraduate Medical Training University based medical degree (Medical Student) Health Service based Pre-vocational Training (Intern & Resident) Health Service based Vocational Training (Registrar) Vocationally qualified specialists or general practitioners Independent Life Long Learning (CPD or CME) CMO, Locum etc. Staff Medical Officers(mostly working in Career Medical Officer or senior medical resident grade positions) Phase Four Phase Three Phase One Phase Two

4. Medical Careers – the need for reform? • Workforce maldistribution • Specialty maldistribution: - aged care, psychiatry, academic medicine general practice • Decline of generalism • Limited training exposure to ambulatory medicine • Limited training exposure to private hospitals and consultant rooms • Economic viability of the current model

5. Medical Careers – who are the players? • Medical Graduates • The Colleges • The Community • The Commonwealth • The States and Territories

6. Medical Careers – is there a Problem? I graduated ... in 2005 and since then have been working ... in differing areas of practice, including multiple locum GP positions under the Rural Locum Relief Program. I never really found a niche of medicine that quite fit. ... at the end of this year I should complete my Masters in Public Health... My interest lies in preventive practice on a community, yet clinical scale. General practice seems like the most suitable pathway to lead to such practice, but the thought of full-time general practice in a consulting room for 2 years would seem to draw me away from such broader principles...and in truth makes me uncomfortable... Any suggestions you could offer would be much appreciated. - email received August 2012

7. Medical Careers – is there a Problem? • 85.7% of doctors were moderately or very satisfied with their jobs • Key factors associated with high job satisfaction • Job characteristics - Realistic patient expectations - Good professional support networks - Being able to take time off • Geographical factors - Friends and family locally - Working outside New South Wales • Doctor characteristics -Being younger or close to retirement - Good self-reported health - High household income MABEL longitudinal survey of doctors

8. Professional Competencies Frank, JR. (Ed). 2005. The CanMEDS 2005 physician competency framework. Better standards. Better physicians. Better care. Ottawa: The Royal College of Physicians and Surgeons of Canada.

9. Professional Competencies – How well do we support their development?

13. The Role of the Colleges

14. The Future of the Colleges?

15. Career Pathways / Development Continuum of Medical Education Postgraduate Medical Training University based medical degree (Medical Student) Health Service based Pre-vocational Training (Intern & Resident) Health Service based Vocational Training (Registrar) Vocationally qualified specialists or general practitioners Independent Life Long Learning (CPD or CME) CMO, Locum etc. Staff Medical Officers(mostly working in Career Medical Officer or senior medical resident grade positions) Phase Four Phase Three Phase One Phase Two

16. Career Pathways / Development Continuum of Medical Education University based medical degree (Medical Student) Health Service and Community based Pre-vocational Training (Intern & Resident) Health Service and Community based Vocational Training (Registrar) Vocationally qualified specialists or general practitioners Heath Service and Community based Vocational Training (?”Registrar”) Vocationally qualified specialists or general practitioners Heath Service and Community based Vocational Training (?”Registrar”) Vocationally qualified specialists or general practitioners Phase One Phase Two Phase Three Phase Four

17. “Change Drivers” in the Community • Clinical • Demographic / Societal • Economic

19. Genomics

21. Historical and projected Australian Population, 1911-2030 Source: Australia’s Health 2012 - AIHW

22. Prevalence of Disability by Age, 2009 Source: Australia’s Health 2012 - AIHW

23. Death rates from cardiovascular disease, 1907 - 2009 Source: Australia’s Health 2012 - AIHW

24. Prevalence of Obesity, 2007-2008 Source: Australia’s Health 2012 - AIHW

25. Trends in mortality rates for all cancers combined 1968-2009 Source: Australia’s Health 2012 - AIHW

26. Health Spending as a proportion of GDP, 2009 Source: Australia’s Health 2012 - AIHW

27. Total funding for health, by source, 1999-2010 Source: Australia’s Health 2012 - AIHW

28. Starfield et al - 2005 • Evidence of the health-promoting influence of primary care has been accumulating…and shows that primary care helps prevent illness and death (in contrast to specialist care) and is associated with a more equitable distribution of health in populations • (Hewlett et al2005) indicated that about 75 percent of visits to a pulmonary specialty clinic were just for “checkups,” even though the patients’ primary care physicians, once they had access to the specialists’ reports, could just as easily perform this function and report the findings to the specialists.

29. What Factors affect Workforce Demand? • Demographic Change • Workplace settings – workplace redesign and substitution • Economic growth, including increased health literacy • “Supplier induced demand” • “Supply induced demand” • Unpredictable changes in diseases and their treatment Health Workforce Australia – Health Workforce 2025 Volumes 1 and 2

30. Do we have the Answers?

31. Are there enough (Vocational Training) Jobs? • What workforce do we need? • Do we have the capacity to train the workforce we need? • Will anyone miss out?

32. “There will be jobs......but they won’t be the same jobs” www.thepunch.com.au/ images/uploads/nicholson

33. Health Workforce 2025 - Medical

34. Health Workforce 2025 - Nursing

35. 1. What workforce do we need? • How do we know what we need? • Status Quo vs. Future requirements? • Data Sources • HWA – Volume 3 Medical Specialties – coming soon! • AIHW • GPET • ? Other groups

36. Training Places Registrars - Accredited Facilities / Trainers by Training Year

37. 2. Do we have the training capacity? • Where do people train, and what levers do we have to increase capacity?

38. Training Capacity (2003-2010) AGPT Registrars and accredited facilities/trainers by training year

39. Do we have the training capacity? • Where do people train, and what levers do we have to increase capacity? • NSW IMET Intern capacity work – 2010 • Hospitals (public) • little underutilised capacity • expansion is possible but will cost money • Maximum 5-10% increase via “reconfiguration” • Hospitals (private) – yes, but will cost money • Private community sector – yes, but will cost money

40. Career Development in a Changing World– Can we do it? • It is Bismarck who reputedly observed that those who love sausages or laws or both should not watch them being made. • He could have said much the same about health policy, certainly the health policy on the table at this election Professor Stephen Leeder (Director of the Menzies centre for health Policy) - SMH - August 19, 2010

41. Career Development in a Changing World– Can we do it? Yes you can! Thank you… Have fun… Make a difference !