In 2010, the Australian Bureau of Statistics Labour Force Survey found that there were 500,600 employed people in direct health-care occupations. The rest (236,800) held other occupations (hospital caterers, hospital cleaning staff, clerical workers, etc), and 266,200 people in health occupations were not working in health services industries but in other industries that support and complement health care (health professionals teaching at university, dietitians in sport and recreational facilities, pharmacists working in pharmaceutical manufacturing, and so on).6
Figure 2.1: Australia’s health workforceD
Source: Australian Institute of Health and Welfare, Australia’s health 2012. p 495
Medical practitioners work in various health care settings using their knowledge and skills as qualified health practitioners. Under the National Law, a medical practitioner is a person who holds registration with the Medical Board of Australia (MBA).7 A medical practitioner is a person whose primary employment role is to diagnose physical and mental illnesses, disorders and injuries and prescribe medications and treatment to promote or restore good health. Within the scope of medical practitioners there are many different titles including but not limited to clinicians and non-clinicians, specialists and non-vocationally trained medical practitioners.
To become a medical practitioner, students must undertake a university undergraduate course ranging from four to six years full-time study. When medical practitioners have completed their studies at university they receive provisional registration and enter the medical workforce as interns (also referred to as postgraduate year 1 – PGY1). An internship lasts for 12 months and is designed to broaden a medical graduate’s clinical expertise. Internships are primarily undertaken in hospitals, but may include placements in community settings such as general practice. When medical practitioners have completed their internship they are granted general medical registration by the MBA. Doctors often spend several years working in the hospital system to broaden their clinical experience prior to commencing specialist training. This period of on-the-job training is known as residency or PGY2 and PGY3.
Specialists are vocationally trained medical practitioners specialising in a chosen medical field. A large number of specialist disciplines are recognised in Australia, including general practitioner (GP), medical administration and medical academic/researcher. After receiving general medical registration, medical graduates undertake specialist training of between three and seven years and are known as registrars. Upon completing this training, specialists must pass examinations leading to membership of the appropriate professional college to be registered to practise in that specialty.
Clinicians are medical practitioners who spend the majority of their working hours involved in the area of clinical practice. The clinical group comprises several subfields: general practitioner, hospital non-specialist, specialist, registrar (trainee specialist) and other clinicians. A non-clinician is a medical practitioner who spends the majority of their working hours involved in non-clinical practice. This can include health administration, education or research.
General practitioners are defined as specialists trained to provide care for individuals in a whole of person approach and in the context of their work, family and community. General practitioners care for people over a period of their lifetime and across all disease categories.
Nursing and midwifery
Nurses and midwives provide direct clinical and personal care to patients and are involved in the education of patients around health and disease management and health promotion activities. Nurses and midwives practise in many settings including the home, community, hospitals, residential and extended care settings, clinics or health units, and educational institutions.
Registered nurses provide nursing care to people of all ages and cultural groups, including individuals, families and communities. Registered nurses assess, plan, implement and evaluate care in collaboration with individual/s and multidisciplinary health care teams to achieve outcomes. The role of the registered nurse includes promotion and maintenance of health and prevention of illness for individual/s with physical or mental illness, disabilities and/or rehabilitation needs, as well as alleviation of pain and suffering at the end stage of life. The minimum qualification for a registered nurse is a Bachelor degree.
Midwives work in partnership with each woman to give support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures. The midwife has an important
counselling and education, not only for the woman, but also within the family and the community. Midwives can first qualify as a registered nurse and then undertake additional education and supervised clinical practice in midwifery or undertake direct entry midwifery programs. Direct entry midwives are registered to practise midwifery only; whereas other midwives are also able to practise general nursing, providing they maintain currency requirements to do so under NRAS.
Nurse practitioners are registered nurses who have completed both advanced university study (at Masters degree level) and extensive clinical training to expand upon the traditional role of a registered nurse. Nurse practitioners are also required to complete an NRAS accredited and approved program of study in prescribing medicines. They use extended skills, knowledge and experience in the assessment, planning, implementation, diagnosis and evaluation of care required. Through their training and expertise, nurse practitioners are able to autonomously perform advanced physical assessment, order diagnostic tests, interpret the results of these tests, initiate referrals to relevant health providers, and prescribe appropriate medications and other therapies as needed.
Eligible midwives work in collaboration with a specified medical practitioner, and can provide Medicare rebate-able antenatal services, care during labour and delivery in a hospital setting (including a hospital birthing centre) and postnatal care for the first six weeks post-delivery. Eligible midwives can also request a range of diagnostic tests, refer patients to obstetricians and paediatricians and prescribe certain medicines under the Pharmaceutical Benefits Scheme (PBS). To attain status as an eligible midwife for Medicare purposes under the National Law, midwives’ qualifications and experience are examined to ensure the high standards required by the Nursing and Midwifery Board of Australia’s eligible midwife registration standard are met. Eligible midwives are also required to complete an NRAS accredited and approved program of study in prescribing medicines.
Enrolled nurses work under the supervision of a registered nurse or midwife to provide patient-centred nursing care including recognition of normal and abnormal in assessment, intervention and evaluation of individual health and functional status. Responsibilities also include providing support and comfort, assisting with activities of daily living to achieve an optimal level of independence, and providing for emotional needs of individuals. Where state law and organisational policy allows, enrolled nurses may administer prescribed medicines or maintain intravenous fluids. Registration requirements for enrolled nurses include completion of an accredited Diploma level course.
Assistants in nursing and personal care workers provide direct personal care to older and more vulnerable members of the community and are employed mostly in the aged care and disability sectors in both residential and community care settings. They are also employed in the acute and sub-acute health care sectors. There are no mandated qualifications for the workforce, however Certificate III is the common standard.
Dentists diagnose and treat dental disease, injuries, decay and malformations of the teeth, periodontal tissue (gums), hard and soft tissue found in the mouth and other dento-facial structures using surgery and other techniques. To register as a dentist in Australia, a student must undertake a five-year undergraduate degree or a four-year graduate-entry degree if they have previously completed a bachelor degree in any discipline. This includes both theoretical knowledge and clinical training.
Dentists are assisted by a number of other oral health practitioners who often work beside or under their supervision. Training programs for dental hygienists, dental therapists and oral health therapists are primarily three-year bachelor degree programs, however there are also accredited courses at the graduate diploma and associate degree level.
Dental hygienists carry out preventative dental procedures under the direction of a dentist. To register as a dental hygienist in Australia, students must complete a three-year Bachelor of Oral Health degree or a two-year Advanced Diploma in Dental Hygiene.
Dental prosthetists are responsible for the construction and fitting of dentures and sporting mouthguards. They maintain, repair and reline dentures either by direct consultation with a patient or by referral from a dentist. Training for dental prosthetists is provided through vocational education training (VET) advanced diploma courses.
Dental therapists examine and treat diseases of the teeth in preschool, primary and secondary school children under the supervision of a dentist. After completing an undergraduate degree a dental therapist can undertake additional training to further specialise in oral health.
Oral health therapists are a new dental profession representing those with dual qualifications as hygienists and therapists, more recently qualified in a newly introduced Bachelor degree in Oral Health. Oral health therapists provide a wide range of dental care in a variety of settings to children, adolescents and adults.
Dental assistants and dental technicians are members of the dental practitioner workforce that are not required to register with the Australian Dental Board. Dental assistants prepare patients for dental examinations and assist other dental practitioners to provide patient care. Dental technicians construct and repair dentures and other dental appliances. Dental assistants and dental technicians have usually completed a VET-based course at the certificate, diploma or advanced diploma level.
The term ‘allied health’ represents various health disciplines, excluding doctors, nurses and midwives, and dentists. The definition of allied health can vary depending on context. The list below is not exclusive.
Allied health professionals work across a number of settings. For most allied health professions the minimum training requirement is an undergraduate degree, however, many may complete postgraduate degrees and in the case of some professions, including but not limited to audiology, pharmacy and psychology, a period of postgraduate supervised practice or training is required.
Aboriginal and Torres Strait Islander health practitioners provide clinical and primary care for Aboriginal and Torres Strait Islander individuals, families and community groups. In order to become a registered Aboriginal and Torres Strait Islander health practitioner, students must complete a VET Certificate IV qualification, this may be which may be undertaken as part of a traineeship or apprenticeship.
Audiologists provide diagnostic assessment and rehabilitation services related to human hearing defects. To be an accredited audiologist, students are required to complete a two year postgraduate degree at the Masters level.
Chiropractors provide diagnosis and treatment of neuromuscular disorders, with an emphasis on treatment through manual adjustment and/or manipulation of the spine. To become a registered chiropractor in Australia students must complete an accredited five year undergraduate university degree.
Chinese medicine practitioners provide holistic health care that may include (but is not limited to) acupuncture, herbal medicine, Chinese massage and breathing exercises in order to prevent and treat disease. In order to become a registered Chinese medicine practitioner students can undertake a number of tertiary VET and university courses.
Dietitians assist individuals, groups and communities to attain, maintain and promote health through good diet and nutrition. To be eligible through the Dietitians Association of Australia (DAA), dietitian students must undertake a three to four year university undergraduate course accredited by DAA. Dietitians can then choose to become an accredited practising dietitian by meeting certain criteria.
Medical radiation practitioners operate X-ray and other radiation producing and imaging equipment for diagnostic, monitoring and treatment purposes under the direction of radiologists and other medical practitioners. In order to become a registered medical radiation therapist, students need to undertake a three to four year university undergraduate course.
Occupational therapists assess the function of people whose abilities are impaired and assist people to participate in the activities of everyday life. To become a qualified occupational therapist, students must complete a four-year university undergraduate course in occupational therapy or postgraduate Masters degree.
Optometrists perform eye examinations and vision tests to determine the presence of visual, ocular and other abnormalities, and prescribe lenses and other optical aids or therapy. To become a registered optometrist, students need to complete a four- to five-year university undergraduate course, with postgraduate qualifications available to specialise.
Osteopaths use techniques such as stretching and massage for general treatment of the soft tissues (muscles, tendons and ligaments) along with mobilisation of specific joints and soft tissues to treat injuries and illnesses. To be a registered osteopath, five years of university study is required.
Pharmacists prepare or supervise the dispensing of medicines, ointments and tablets and advise members of the public and other health professionals about medicines, including appropriate selection, dosage and drug interactions, potential side effects and therapeutic effects. To be registered as a pharmacist, students need to undertake a three to four year undergraduate pharmacy degree, complete approved supervised practice, complete an intern program and pass written and oral examinations.
Physiotherapists assess, treat and prevent disorders in human movement caused by injury or disease. To be registered as a physiotherapist, students must undertake a four-year undergraduate degree or postgraduate (Masters) degree.
Podiatrists prevent, diagnose and treat health conditions of the lower limbs, including those resulting from bone and joint disorders, muscular pathologies as well as neurological and circulatory diseases. To be registered as a podiatrist, students must complete a three- to four-year undergraduate degree.
Psychologists are experts in human behaviour, having studied the brain, memory, learning, human development and the processes determining how people think, feel, behave and react. Psychological therapies are used to treat individuals and families and can also be applied to groups and organisations. To become eligible for general registration as a psychologist there are three different pathways including a four-year undergraduate degree followed by a two-year internship, a five-year undergraduate degree followed by a one-year internship or an accredited postgraduate degree.
Social workers work with individuals, groups and/or communities in times of crisis. Their clients may include families, students, hospital patients or the elderly. To become an accredited social worker students can undertake either an undergraduate or postgraduate (Masters) degree.
Speech pathologists assess and treat people with communication disorders including speech, language, voice, fluency and literacy difficulties or people who have physical problems with eating or swallowing. To become an accredited speech pathologist, students can undertake either an undergraduate or postgraduate (Masters) degree.
Allied health professionals in Australia
There is limited data available on allied health disciplines, especially those not included in the NRAS. HWA has commenced work on Health Workforce 2025 – Selected Allied Health Professions.
The professional boards registered under the NRAS release quarterly registration numbers for each profession with limited demographic details. There were 11 allied health professions registered under NRAS as of December 2012 and the total number of registered professionals was 128,508 which includes those with provisional registration.
The allied health professions account for 22.1% of the total registrations across all registered health professions. The table below shows the number of registrations by profession and the percentage of these across all registered allied health practitioners.12
|Professions||Number of registrations||Percentage of total registrations|
|Aboriginal and Torres Strait Islander health practitioners||298||0.2%|
|Chinese medicine practitioners||3,952||3.1%|
|Medical radiation practitioners||13,508||10.5%|
The size of the allied health workforce has increased in recent years. The limited demographic data available from the national boards in the NRAS show that the median age of most allied health professionals is between 36 and 40 years of age with occupational therapists being younger with the median age, between 31 and 35 years of age. Aboriginal and Torres Strait Islander health practitioners, optometrists and psychologists had a median age of between 41 and 45 years of age and Chinese medical practitioners had a median age between 46 and 50 years, the oldest of the allied health professionals. Registration data also shows that allied health professions tend to be female dominated with the exception of chiropractors, which is a very male dominated profession. There is little data available for non-registered allied health professionals.
The above workforce demographics assist us to understand the current state of the health workforce and the current challenges in delivering services to the community. The nursing and midwifery workforce accounts for approximately 60% of the health workforce and plays a major role in direct patient care. The medical workforce is the next largest at approximately 16% of the workforce and is tasked with both frontline primary care and acute care. Overall, medical practitioners, nurses, midwives, and dental practitioners account for approximately 77% of the registered health workforce. Therefore, their distribution, work practices and ageing profile heavily affect the supply of health services.
Age and gender
As can be seen above, the medical, nursing and midwifery, dental and some allied health workforces are quite aged compared with the median age of Australia’s workforce14 and the proportion of those aged 55 years or older rose from 15% in 2005 to 19% in 2010.15 The ageing workforce not only impacts on the future supply of health professionals but also on the quantity of current working hours as older workers tend to work fewer hours. Labour force survey data shows average working hours of health professionals are reducing and research shows that the working hours of future graduates will continue to fall.16 The increasing feminisation of the health workforce has been postulated to have a major impact on the total hours worked as some segments of the female workforce traditionally work fewer hours than their male counterparts due to family commitments. However the male workforce average weekly working hours have also been decreasing. The average weekly working hours for male doctors fell approximately four hours between 1999 and 2009, from 48.4 to 44.9.17 This fall in male average hours has occurred across all age groups.
Given the ageing of the workforce and reduction in work hours from both genders, the increasing training, graduation and recruitment of the total number of health workers has in fact led to only a small net increase in the number of full-time equivalent (FTE) practitioners.18
It is widely recognised that the geographic spread of the health workforce does not reflect the distribution of the population. With the exception of nurses and midwives, the relative number of health professionals diminishes for communities located further away from major centres. Nursing and midwifery staff-to-population ratios actually increase in inner and outer regional areas before declining in remote and very remote areas and the midwifery staff-to-population ratio is the least in major cities.19 Allied health, dental practitioners and medical specialists are in severe shortage in outer regional, remote and very remote areas.
The shortage of health professionals in rural and remote areas further exacerbates workload pressures for the current health workforce and has been a key focus for this review.
Figure 2.3: Health practitioners per 100,000 population comparative weightings; Remoteness Area to national supply by health workforceD
Sources: AIHW nursing and midwifery labour force survey 2009, AIHW Medical labour force 2009, and AIHW Health and community services labour force 2006
The average age of the nursing and midwifery workforce in regional, rural and remote areas is older than in metropolitan areas. This indicates that while the current distribution is relatively even, the ageing of the nursing and midwifery workforces is likely to lead to a maldistributed workforce in the near future. Allied health professionals are rather unevenly distributed especially in the more rural areas.20 It is important to bear in mind that allied health professions are diverse and some professions are small in number. It would be inherently improbable that these professions would be equally distributed across all regions. The role and scope of practice of different professions also needs to be taken into account. Professionals in regional and remote areas tend to provide a greater mixes of services and different models of service delivery to meet demand.21
In summary, despite recent increases to raw numbers of entrants into Australia’s health workforce, reductions in hours worked and retirements meant that there has in fact been only a small net increase in the number of FTE practitioners. Additionally, the workforce is currently unevenly distributed across geographic regions for many professions and this trend is likely to intensify.
6 Australian Institute of Health and Welfare. Australia’s health 2012. Cat. no. AUS 156. Canberra; AIHW. 2012. p. 495
7 ‘National Law’ refers to the Health Practitioner Regulation National Law Act 2009 which enables the National Registration and Accreditation Scheme (discussed further in Chapter 3).
8 Sources: Australian Institute of Health and Welfare. Medical workforce 2011. National health workforce series no. 3. Cat. no. HWL 49. Canberra, 2013: AIHW; Medical Training Review Panel, Fifteenth Report. Canberra: DoHA; L Hawthorne, Health Workforce Migration to Australia, Policy Trends and Outcomes 2004-2010, Health Workforce Australia, 2012, p. 55
9 Medical Training Review Panel, Sixteenth Report, Commonwealth of Australia, 2013 (not yet released).
10 AIHW. Nursing and midwifery workforce 2011. National health workforce series no. 2. Cat. no. HWL 48. Canberra: AIHW, 2012
11 AIHW. Dental workforce 2011. National health workforce series no. 4. Cat. no. HWL 50. Canberra: AIHW, 2013
12 Australian Health Practitioner Regulation Agency, December 2012 quarterly registration data, accessed on individual board websites at www.ahpra.gov.au, viewed on 20 January 2013.
14 Median age of the Australian workforce was 37 years of age in 2011. The median age is the age that divide the population into two equal groups, half that is younger and half that is older (ABS Labour Force, Australia, Cat no: 6291.0.55.003).
15 Australian Institute of Health and Welfare, Australia’s health 2012, Cat. no. AUS 156. Canberra: AIHW, 2012, p 494
16 National Health Workforce Taskforce, Health Workforce in Australia and Factors for Current Shortages, National Health Workforce Taskforce, Melbourne, 2009, p38
17 Health Workforce Australia, Australia Health Workforce Series – Doctors in focus, Adelaide, 2012, pg 15
18 Health Workforce Australia, Health Workforce 2025 – Doctors, Nurses and Midwives – Volume 1, Adelaide, 2012, p9.
19 Health Workforce Australia, Health Workforce 2025 – Doctors, Nurses and Midwives – Volume 1, Adelaide, 2012, p156.
21 J Humphreys and J Wakerman, Primary health care in rural and remote Australia: achieving equity of access and outcomes through national reform, a discussion paper commissioned by the National Health and Hospitals Reform Commission, 2008.