mygeneralpractice

23 October 2009 General practice workforce update

The Australian Institute of Health and Welfare’s (AIHW)Medical labour force 2007 report was issued last week. Figures contained in the report underscore the need for urgent action to address the GP shortage, particularly in rural and remote Australia, and a looming crisis as the current workforce ages.

General practice workforce shortages are a problem throughout Australia. Though overall GP numbers have increased because of population growth, GP supply (including registrars) has fallen by 2% since 2002. In this time, the supply of other specialists (including specialists in training) has increased by more than 17%. For more than a decade we have known that a falling GP supply increases health costs and worsens health outcomes. Leiyu Shi ¹ has shown us that one extra GP is linked to 70 fewer deaths per 100 000 people. Unfortunately, increased specialist supply is linked to higher costs and increased mortality with one extra specialist linked to 16 more deaths per 100 000 people.

Our GP workforce is ageing, with the average age of vocationally recognised GPs now over 50 years. It is essential that before these GPs retire we harness their skills to train the next generation of doctors. With record applications for the Australian General Practice Training Program we must grow the program so that we don’t turn away applicants. We need to increase places by a minimum of 100 each year with a target of 1500 places by 2015. To fill these places we will need 1000, 3 month prevocational general practice placements by 2012. We also need investment in training infrastructure and better support for our supervisors. The full AIHW Medical labour force 2007 report is available at www.aihw.gov.au/mediacentre/2009/mr20091016.cfm.

What is obvious from the above statistics is that we have work to do to attract the next generation to general practice. Financial reward is not the only issue, but it is important. Beverly Woo ² shows clearly the association between remuneration and selection of a speciality. Improved recognition and remuneration of general practice is essential if we are to turn around Australia’s GP shortage. The 2009–2010 Federal Budget included $9.3 million (over 2 years) to undertake a review of the Medical Benefits Schedule (MBS). This provides an opportunity to simplify the MBS and better reward general practice.

With an ageing population and the increase in conditions such as diabetes and heart disease, Australia’s chronic disease burden will only increase. General practice is the place for targeted, preventive health measures and it is essential that the government’s National Preventative Health Taskforce listens to the college’s feedback to its ambitious plans to make Australia the ‘healthiest country by 2020’. See www.preventativehealth.org.au. The RACGP briefing to members on ‘Australia: the healthiest country by 2020’ is at www.racgp.org.au/healthreform. To comment or provide input, please email healthreform@racgp.org.au.

The college supports the proposed initiatives aimed at educating young Australians, lower socioeconomic groups and Indigenous Australians on health related issues. However, a coordinated message must be combined with targeted individual preventive activities to all our patients through general practice. The RACGP’s ‘red book’ (www.racgp.org.au/guidelines/redbook), ‘green book’ (www.racgp.org.au/guidelines/greenbook) and strategies such as the Smoking, Nutrition, Alcohol and Physical Activity (SNAP) framework (www.racgp.org.au/guidelines/snap), are available to support prevention in our practices. To replace and simplify the complicated range of age specific health assessments we need to develop a single preventive health item based on the ‘red book’. 1. Shi L. The relationship between primary care, income inequality, and mortality in US States, 1980-1995. J Am Board Fam Pract 2003;16:412-22.
2. Woo B. Primary care - the best job in medicine? N Engl J Med 2006;355:864-6.

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