Rich told: stop taking from the poor
Rich countries have been urged to reduce their reliance on overseas-trained doctors and improve workforce planning to help address severe shortages of medical practitioners in developing nations.
A dramatic upsurge in the number of doctors has averted fears of a world-wide doctor shortage, but the Organisation for Economic Cooperation and Development said large numbers were flocking to wealthy nations from Africa, exacerbating problems with access to care among the poor.
According to the OECD report Health Workforce Policies in OECD countries: Right Jobs, Right Skills, Right Places, there were 3.6 million doctors practising among its member countries in 2013, up from 2.9 million in 2000 – a 24 per cent increase in just 13 years.
Much of this increase has been driven by a sharp expansion in medical school intakes and training programs.
Australia has been part of a global trend toward boosting medical school intakes – since 2004, the number of medical school places has soared by 150 per cent to reach more than 3700, creating problems further along the training pipeline, where there has not been a commensurate increase in capacity.
But the growth in doctor numbers has also been fuelled by recruitment from overseas.
The report found that 17 per cent of all active doctors working in OECD countries came from overseas, and though a third originated in other OECD nations, “large numbers also come from lower-income countries in Africa that are already facing severe shortages”.
While the United States and the United Kingdom are the two most popular destinations for overseas-trained doctors, Australia is among the most heavily reliant on them to help plugs gaps in the medical workforce.
They comprise about a quarter of all doctors working in Australia, and make up more than 40 per cent of those practising in rural and remote regions.
The OECD said this reliance was coming at a heavy cost to poor countries that were training doctors, only to see many of them emigrate rather than ease the local shortage.
OECD Secretary-General Angel Gurria said that with the threat of a global doctor shortage averted, it was time to focus attention on improving the distribution of the medical workforce to ensure all had access to high quality care.
“The evolving health and long-term care needs of ageing populations should stimulate innovation in the health sector, where attention should focus on creating the right jobs, with the right skills, in the right places,” Mr Gurría said. “Countries need to co-operate more to ensure that the world gets the strategic investments in the health workforce that are necessary to achieve universal health coverage and high-quality care for all.”
The AMA has anticipated the OECD’s call, late last year releasing a Position Statement recommending that Australia not recruit doctors from countries which have an even greater need for them.
Australia is already a signatory to the World Health Organisation’s Global Code of Practice on International Recruitment of Health Personnel, which calls for improved workforce planning to allow nations to respond to future needs without relying “unduly” on the training efforts of other countries, particularly low-income ones.
But some researchers have argued that not only would it be unfair to constrain the ability of doctors from poorer countries to choose where they would like to practice, but such restrictions could also have the perverse effect of discouraging people in these locations from considering a career in medicine, exacerbating the shortage of medical workers.
AMA Vice President Dr Stephen Parnis said that improved workforce planning was an “urgent priority”.
The Abbott Government abolished Health Workforce Australia and absorbed its functions within the Health Department, a move Dr Parnis condemned as short-sighted.
In its final report, the HWA confirmed that Australia had sufficient medical school places, and instead urged attention on improving the capacity and distribution of the medical workforce – a task that the AMA hopes the National Medical Training Advisory Network will be able to fulfil.
A particular concern is difficulties in recruiting and retaining doctors in rural and regional areas.
The OECD has urged countries to use a mix of financial incentives, regulations and technologies such as telemedicine to help reduce regional disparities in access to care.
The Federal Government has announced the establishment of 30 regional training hubs and an expansion of the Specialist Training Program, but the AMA has voiced doubts that these initiatives on their own will be enough, and has instead called for a third of all domestic medical students to be recruited from rural areas.
The Government has so far resisted the suggestion, and Health Minister Sussan Ley told the AMA Federal Council last month that she was “not interested” in imposing regulations that would tie doctors to practice in a particular geographic area.