National Medical Workforce Benchmarks

Draft – not for public distribution

National Medical Workforce Benchmarks

Background Paper

Prepared by

Col White

Queensland Rural Medical Support Agency

Queensland Rural Medical Support Agency 2002

This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced without prior written permission from the Queensland Rural Medical Support Agency. Requests and enquiries concerning reproduction and rights should be directed to the Queensland Rural Medical Support Agency, PO Box 167, Kelvin Grove DC, Qld 4067.

Suggested citation

White, C. (2002). National medical workforce benchmarks: Background paper prepared for Australian Rural and Remote Workforce Agencies Group. Brisbane: QRMSA.

QRMSA Background Paper – National Medical Workforce Benchmarks

Draft – not for public distribution

National Medical Workforce Benchmarks

The purpose of this paper is to document current benchmarks cited in the available literature and electronic files in relation to doctor to population ratios and general practice service provision in Australia.

Given the known and documented disparities between urban and rural areas and, to a lesser extent between states/territories, this paper will concentrate on national averages in relation to general practice service provision.

In its initial report, Australian Medical Workforce Benchmarks (AMWAC, 1996) the advisory committee contended that the whole point of establishing benchmarks for medical workforce is to provide the basis for predicting what workforce size and composition will be desirable in the future, and to monitor whether the desirable level has been achieved (AMWAC, 1996 p,xxi).

Based on 1994 data, AMWAC suggested that the general practitioner workforce (estimated at 18,673) was in considerable oversupply in the capital cities and other major urban areas of Australia and that there was a considerable undersupply in rural and remote areas. The urban oversupply was estimated at 4,400 (numbers) or 2,900 full time equivalents (FTE) and rural undersupply at around 500 or 445 full time equivalents. The report also recommended that the 1994 benchmark for supply of medical workforce in Australia be 205 FTE clinical practitioners per 100,000 population. Factoring in growth in demand due to population changes and ageing (1.17% per year) and growth due to other factors (0.6%) per year, AMWAC estimated that this would increase the benchmark to 220 FTE clinicians per 100,000 population in 2005.

In a subsequent report, Medical Workforce Supply and Demand in Australia (AMWAC, 1998) the committee suggests that in Australia in December, 1995 there were 253.8 practising clinicians per 100,000 population. The national average for the primary care practitioner workforce was estimated at 115.8 per 100,000 population. This equates to a doctor to population ratio of 1:864.

The report also suggests that feedback from participants at the General Practice Research Workshop held in Adelaide, October 1997 suggests that large rural centres (population from 25,000 to 99,999) generally have an adequate supply of GP’s, and it is in rural areas outside of these that workforce shortages are a significant problem (AMWAC, 1998). The report notes that in 1995, these centres had an average of 106.5 GPs per 100,000 population. If Whyalla (which had a significant below average ratio) was excluded, the average became 107.6 per 100,000 (1:929). The report suggests that if this provision is accepted as representing a lean but adequate GP supply for large rural centres, then the 128.6 GPs per 100,000 population (1:778) in metropolitan areas represents a surplus of around 20% (approx 3,300 GPs).

The report, General Practice in Australia (CDHAC, 2000) notes that while ‘head counts’ of doctors are a measure of workforce planning, the geographic variation in the proportion of doctors working part time restricts the usefulness of the measure. As such, a common workload unit is required to provide comparability. One such unit that has been developed is the full-time workload equivalent (FWE). This is calculated for each doctor by dividing the doctor’s Medicare billing (schedule fee value of claims processed by the HIC during the reference period) by the mean billing of full-time doctors. As an example, a FWE value of 2 indicates that the doctor’s total billing is twice that of the mean billing of a full-time doctor. The mean billing of full-time doctors for the reference period 1998-99 was $183,332 (CDHAC, 2000 p. 43). For the 2001-2002 reference period the mean billing was $203,857

Previous estimates which used full-time equivalents (FTE’s) based on the HIC definition of full-time as a billing income of $73,241 or more, over a 12 month period attracted criticism as it was considered that this income level was too low for most full-time GP’s. Use of FWE’s is claimed to overcome this limitation. The full-time/part-time cut-off value used by HIC for the 2001-2002 reference period was $81,097.

As noted above, ‘head counts’ are subject to certain limitations. They include varying proportions across geographic class of doctor working part time or only part of the year in general practice. Additionally, they do not take into account relative differences in population growth across regions. As such, it is claimed that FWEs and FWEs per 100,000 population should provide a better indication of changes in workforce supply in respect of GP services rendered, and the change in doctor to population ratios (CDHAC, 2000 p.63).

For the period 1998-99, the CDHAC General Practice in Australia report claims that the national population per FWE ratio was 1:1153. This ratio differs somewhat from data for the same period provided by CDHAC (2001) and Healthwiz (2000) that report national population per FWE ratios of 1:1076 and 1:1100 respectively.

While appearing to advocate the use of FWE ratios, the report, General Practice in Australia (CDHAC, 2000) reverts to head counts and suggests that the national average in December 1998 was 111.3 GPs per 100,000 population, which equates to 898 persons per GP or a ratio of 1:898 (p. 47).

The Australian Medical Workforce Advisory Committee (AMWAC, 2000) suggests that at December 1998 the national average of GPs per 100,000 population was 110.6. This equates to a doctor to population ratio of 1:904 (p. 35). This ratio is also supported by The Australian Medical Workforce - Occasional Papers New Series No. 12 report (CDHAC, 2001 p. 42).

In assessing the adequacy of current general practitioner workforce, AMWAC has contended that in 1998-99, the average full-time GP provided 6,400 Medicare/DVA patient billed attendances and this equates to 7,185 patient encounters per year after adjusting for non-Medicare/DVA work. Based on data from large rural centres (RRMA 3), AMWAC also estimated that the GP workforce provides for 7.1 patient encounters per capita per year with private practice accounting for 6.2 encounters and 0.9 encounters being provided from public hospitals. It is these figures, (7.1 average patient encounters per capita per year) and the 7,185 patient encounters per year which provide the basis of AMWAC supply requirements.

The AMWAC working party concluded that: on balance the situation in large rural centres best represented the situation where supply and need were in balance, and that as such the situation in large rural centres, as a whole, could be used as a benchmark for assessing the adequacy of GP supply (AMWAC, 2000 p.60). As there is very little GP activity in metropolitan based public hospitals, the benchmark for population need for GP services for the metropolitan GP workforce was set at 6.2 patient encounters per capita per year (AMWAC, 2000 p. 9-10). Based on these benchmarks, the AMWAC report implies a doctor to population ratio of 1:1012 for rural areas and uses this figure as a basis for its supply estimations.

The report further estimates that nationally, in December 1998, there was a notional excess of GPs above the supply benchmark of 1,070. To ensure that projected requirements for GP services in 2010 balance with the expected workforce supply in 2010, the increase in the requirements for GP services over the period 2000-2010 was estimated at 12%, an average annual increase of 1.13% per year. The workforce requirement in 2010 is therefore an increase in FTE GPs of 1.13% per year from the 1998 starting point in the data, minus the estimated level of supply in excess of the benchmark in 1998 of 1,070 (AMWAC, 2000).

A further source of data in assessing medical service provision in Australia is the Health Insurance Commission. HIC data sourced from the Department of Health and Aged Care and the Healthwiz program suggests that the averaged doctor to population ratio (nationally) over the two-year period 1997-98 to 1999-99 was 1:1097. These ratios are based on fulltime workload equivalents and use 1996 ABS census data for population estimates.

In a letter to Rural Workforce Agencies dated 29 October, 2000, the then Secretary, of the Commonwealth Department of Heath and Aged Care contended that the national average doctor to population ratio was 1:1280 and that the Department would allow placements under the Rural Locum Relief Program in RRMA 3 locations where this ratio was exceeded by 10% (i.e., 1:1400). Subsequent discussions with representatives from the Commonwealth Department of Health and Ageing (July, 2002) have indicated that these ratios are based on Full Time Equivalents (FTE’s) and not Fulltime Workload Equivalents (FWE’s) as used in the calculation of usually reported doctor to population ratios. RWA’s have also been advised that the current ratio used for District of Workforce Shortage determinations is 1:1396 (November, 2002).

More recent data prepared by the then Commonwealth Department of Health and Aged Care for the Productivity Commission (Report on Government Services, 2002) suggests that nationally there were 85 FWE GPs per 100,000 people. This equates to a FWE GP population ratio of 1:1176. Additionally, data provided by the department also suggests that the total number of GP’s for the 2000-2001 period was 24,249. This figure is somewhat higher than the 20,852 estimate provided by the Australian Institute of Health and Welfare (AIHW, 2000) that was used by AMWAC (2000) as the basis for its supply and requirements modelling.

Table 1 provides data over a 5-year period in relation to number of GP’s and FWE’s for RRMA 4 to 7 locations.

Table 1 Total GPs and FWE GPs by RRMA

Number

RRMA4 / RRMA5 / RRMA6 / RRMA7 / Total
96-97 / 1288 / 2300 / 237 / 359 / 4184
97-98 / 1310 / 2306 / 246 / 442 / 4304
98-99 / 1374 / 2398 / 299 / 475 / 4546
99-00 / 1456 / 2519 / 313 / 476 / 4764
00-01 / 1476 / 2619 / 299 / 455 / 4849
FWE’s
96-97 / 923 / 1504 / 120 / 125 / 2672
97-98 / 934 / 1509 / 122 / 134 / 2699
98-99 / 926 / 1513 / 119 / 142 / 2700
99-00 / 951 / 1526 / 118 / 142 / 2737
00-01 / 996 / 1601 / 124 / 150 / 2871

Source DHAC (unpublished) from Productivity Commission Report on Government Services 2002

To compound matters further, a recent survey released by the Australian Bureau of Statistics (ABS) on the 29th October 2002 suggests that were 18,867 general practitioners (GPs) in Australia. Again this number differs significantly from those reported by the AIHW, AMWAC and DHAC. The ABS report contends that the distribution of general practitioners by states and territories was very similar to the distribution of the Australian population and suggests that on average, there were 0.96 general practitioners for every 1,000 persons in Australia. This equates to a doctor to population ratio of 1:1042. Some caution should be exercised in the interpretation of the ABS findings. The ABS findings were based on a random sample of approximately 1,600 GP’s and 1,600 Specialists (Bruce Fraser, ABS, personal.comcommunication, November 1, 2002. Bruce Fraser, ABS, 1/11/02) and may be subject to greater error than that estimated.

A common source of error in all estimates of GP service provision is defining who is a General Practitioner and what services should be included/excluded. While some common definitions do exist, the ways in which they are interpreted and applied can vary considerably across states, territories and health jurisdictions.

Appendix 1 provides an overview of estimates of the Primary Medical Care (GP) workforce by data source and measurement unit utilized over the past five years.

Conclusion

It is relatively clear from the above summary that there is a considerable lack of clarity and some degree of uncertainty as to what are appropriate benchmarks to utilize for effective workforce planning. Data in relation to GP service provision in Australia appears to be consistently inconsistent and varies depending on the source and whether numbers, FTE’s or FWE’s are being considered. Often they are used interchangeably which serves to compound the confusion. The many differing estimates of doctor to population ratios as outlined in this paper would suggest that there is a necessity for agencies and departments collating and reporting medical workforce data to collaborate and standardize definitions and measurement procedures.

References

Australian Bureau of Statistics. (2002). Private Medical Practitioners (cat. no. 8689.0)

Australian Institute of Health and Welfare. (2000). Medical labour force 1998 (AIHW Cat. No. HWL15). Canberra: AIHW (National Health Labour Force Series no. 16).

Australian Medical Workforce Advisory Committee, & Australian Institute of Health and Welfare. (1998). Medical workforce supply and demand in Australia: a discussion paper. AMWAC Report 1998.8, AIHW Cat. No. HWL12, Sydney.

Australian Medical Workforce Advisory Committee. (1996). Australian Medical Workforce Benchmarks: AMWAC Report 1996.1. North Sydney: AMWAC.

Australian Medical Workforce Advisory Committee. (2000). The General Practice Workforce in Australia: AMWAC Report 2000.2. Sydney.

Commonwealth Department of Health and Aged Care. (2000). General practice in Australia: 2000. Canberra: General Practice Branch, Department of Health and Aged Care.

Commonwealth Department of Health and Aged Care. (2001). Data file

Commonwealth Department of Health and Aged Care. (2001). The Australian Medical Workforce. Occasional Papers New Series No.12, August 2001. Canberra: DHAC.

Healthwiz (2000). Version 5. Prometheus Information Systems: Canberra

Productivity Commission. (2002). General practice, Report on Government Services 2002. Canberra.