Report on the Audit of Health Workforce in Rural and Regional Australia

5.1 Restrictions on health profession roles

Page last updated: April 2008

The current role of each profession within the health workforce has generally evolved over time as the health sector has developed. The roles are often formalised through registration legislation or registration scope of practice guidelines, which inform the expected roles and responsibilities of current practitioners. Similarly, accreditation requirements for tertiary education providers inform the required curriculum and skills level and knowledge for newly graduating professionals. Registration scope of practice guidelines and accreditation guidelines are generally developed by each profession themselves, often with little interaction with other related professions.

In addition, there is a series of other legislative and financial constraints on each of the professions, at both the national and state and territory levels, which often reinforce, or further restrict, the role and responsibility of each profession.

As an example, the Medicare Benefits Schedule limits the role of health professionals by determining which health services provided by which health professional may be eligible for subsidisation for the patient by the government. While this does not prevent a service from being provided outside of both Medicare and the Pharmaceutical Benefit Scheme, it does mean that it is more difficult for a health practitioner to financially sustain a business providing those services and thus acts as a further limitation on the locations in which health practitioners are likely to work.

Similarly, states and territories may restrict certain health activities to certain professions or subgroups within professions, such as providing assistance to women giving birth.

The major restriction exercised by state and territory legislation in terms of the role and responsibility of health professions is the control exercised in the disbursement, supply and prescription of pharmaceuticals through their drug and poison legislation. At present, there are limited numbers of professionals able to prescribe medication. These are medical practitioners, dentists, nurse practitioners, optometrists, and surgical podiatrists/chiropodists, to varying degrees in each state and territory.

The prescribing of medication is further limited by financial constraints at both the state and territory and Australian Government level. The supply of pharmaceuticals to patients at a reasonable, or no, cost is generally limited to those patients who are currently receiving a state or territory funded health service (such as while in hospital), or who are receiving a service from a health professional who has been authorised to prescribe medication on the Pharmaceutical Benefits Scheme (medical practitioners, dentists and optometrists).

On the whole, these restrictions on the roles and responsibilities of each profession have developed over time to ensure that the safety and quality of health services are maintained for the patient and that the health system remains financially sustainable. Nonetheless, in a rural and remote context, role definitions and limitations can reinforce difficulties rural and regional communities face in accessing particular essential health services which are available elsewhere but only through specialised practitioners.

In more recent times, this issue has been exacerbated by the growing specialisation within health professions. Medical practitioners are now frequently not only specialists, but subspecialists (for example, a paediatrician with a further specialisation in neurology). The number of formally recognised specialisations within each profession continues to grow: in physiotherapy, for example, there are 10 specialities (musculoskeletal physiotherapy, women's health, aged care, chest conditions, occupational health and safety, sports medicine, babies and young children, problems of the nervous system, spinal injuries and administration).

The trend towards specialisation reflects the increasing knowledge base and technological developments in the health sector. This trend has distributional impacts that make it difficult to provide the same types of services in metropolitan and rural and remote locations.

The other major trend within the health sector is the formalisation of the assistant roles, which have emerged with changes in technology, practice and training and include: personal care assistants, some of the dental professions, and roles such as physical therapy assistants.