John Menadue. Have we too many doctors?

There are no international comparisons that I can find that show that we have a shortage of doctors in Australia. In fact, we may be moving into a situation of having a surplus of doctors.  In its “Health at a glance” the OECD found that we are above the average in our supply of doctors. The OECD provided details of “practising doctors per 1000 of population in 2011” for over 40 major countries. The OECD average was 3.2 practising doctors per1000 of population. Australia was slightly above the average with3.3 practising doctor’s per1000 of population. For the Netherlands it was 3.0, for the UK 2.8, for NZ 2.6 and Canada 2.4. The top four countries with over 4 practising doctors per 1000 were Greece, Russia, Austria and Italy. The OECD is quite explicit about trends in Australia It says “in several countries (e.g. Australia, Canada, Denmark, the Netherlands and the UK) the number of medical graduates has risen strongly since 2000 reflecting past decisions to expand training capacity…In Australia the number of medical graduates has increased two and a half times between 1990 and 2010 with most of the growth occurring since 2000”

In 2004 when Tony Abbott was Minister for Health he decided against advice that we had a shortage of doctors. As a result the number of domestic students graduating from medical schools in Australia increased dramatically from 1,287 in 2004 to 2,507 in 2011. It has been described as a “tsunami” of medical graduates. The OECD found that in 2011 with 12.1 medical graduates per 10,000 of population we were well above the OECD average of 10.6. We know that this increase in numbers is making it very difficult to find training places for the increased number of medical graduates.

We also know that with bulk billing and with patient dependence on the advice of their doctor about future appointments, tests and referrals, doctors have an ability to generate work for themselves and other professionals. Doctors can and do drive the demand for their services through fee for service.  That has serious cost implications.
Apart from the total numbers the other important issue is the distribution of doctors across Australia.  All the data shows serious shortages of doctors and other health professionals in rural and remote Australia. These shortages are occurring despite the fact that we now have about 3,000 International Medical Graduates (IMGs) who are tied to areas of need. These IMGs have performed a useful role in rural areas although there has been some concern over language and sometimes professional skills. However it seems logical and legally defensible (“civil conscription”) that if we can determine where IMGs can work, why can’t we do the same for Australian medical graduates and insist that new provider numbers only be issued according to need in Australia. We don’t need more provider numbers and doctors in Belleview Hill and Toorak, but we do need them in rural and remote Australia.  Through governments, taxpayers subsidise medical education and about 80% of the remuneration of doctors comes from government. There is a legitimate interest in new doctors working in areas of need, at least in the early stages of their career. Hopefully they will find professional and personal satisfaction in country areas and decide to stay.

Another option to overcome shortages of doctors in rural Australia would be to auction provider numbers by postcode but that would probably be too radical for many professional people who don’t like open markets.

In short we are moving to a surplus in the total number of practising doctors but serious shortages still exist in rural and remote Australia which could be addressed, at least in part by limiting new provider numbers to areas of need.

Why can we send teachers to areas of need but not doctors?

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4 Responses to John Menadue. Have we too many doctors?

  1. Annie says:

    John, I very much appreciate your offer, but I’m just a Jane Citizen, not a health professional or administrator, and don’t have the knowledge to deveop the idea. I’m looking at the problem from the viewpoint of a client in a regional city, where hospitals and medical practices are paying extortionate salaries for GPs and specialists, and thus ruining the health budget for the state (Tasmania). It just seems to me to be absurd that doctors and other health professionals are free to go wherever they will, funded by the taxpayer. Where’s the accountability? Instead, medical professionals of all types of service should have to apply for a job wherever there is a vacancy, like other people in the public service. The notion of a free market in health care is nonsensical, and has no basis in fact, though the AMA would disopute this. If the ABS stats were used to determine the health profile of a region, MPNs for the required number and type of medical professionals could be set. Qualified people could then apply for one, perhaps on a contract basis. This would allow for the re-allocation of MPNs if the needs of the population change.
    Thanks for your blog – it’s great to have a place to share ideas.

  2. Dion Manthorpe says:

    An interesting & novel concept, Annie. Local councils in areas of real need may welcome such an idea. And it could well apply to visiting specialists too.

  3. Annie says:

    “Another option to overcome shortages of doctors in rural Australia would be to auction provider numbers by postcode but that would probably be too radical for many professional people who don’t like open markets.” Why not allocate Medicare Provider Numbers to localites rather than individuals? Allocations could be based on the community needs, based on community profiles from ABS statistcs. At present, a MPN is a licence to print money. Why should it belong to an individual for life, regardless of community needs?

    • John Menadue says:

      Would you be interested in developing this idea further..allocating provider numbers to localities rather than individuals. Perhaps in a guest blog?
      John Menadue

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