The World Health Organization has long asserted that “health systems can only function with health workers.” In Australia, health practitioners, who constitute a significant subset of health workers, represent 5% of the national workforce, with approximately half being nurses. This workforce is distributed across public and private facilities, spanning primary, secondary, and tertiary care, and is integral to sectors such as disability and aged care. However, this essential workforce is under increasing pressure due to rising service demands, environmental and geopolitical challenges, economic constraints, and ongoing policy reforms.
Between 2013 and 2022, the size of Australia’s health practitioner workforce grew by 37%, with the most significant increases seen among allied health professionals (67%) and medical practitioners (41%). Despite this growth, demand continues to outpace supply, with shortages reported in 82% of occupations in 2023. The COVID-19 pandemic exacerbated these challenges, contributing to workforce attrition and fatigue.
Challenges in Workforce Distribution and Policy Fragmentation
The health workforce in Australia faces issues of maldistribution and inequity of access, leading to deficits in certain healthcare types. Recent royal commissions have underscored the need for a larger, better-trained, and better-paid care workforce, especially in rural and regional areas. The increasing pressure on the health system, combined with fiscal constraints and complex governance, necessitates a consolidated workforce policy to support and strengthen the health system.
In a review published in the Medical Journal of Australia, Topp and colleagues highlighted the fragmented nature of federal health workforce policies. They identified a range of policies focused on specific professions, geographic locations, and areas of healthcare. This fragmentation undermines coordinated workforce planning and equity, suggesting a need for a comprehensive strategy that encompasses the entire health workforce.
The Need for a Comprehensive Strategy
According to the review, while consolidating national health policies is crucial, most of the workforce is employed by state and territory governments, each with its own policies. This fragmented governance has led to a proliferation of policies, but the process and dynamics of policy development remain underexplored. Engaging all stakeholders in policy development is vital, given the diverse distribution of healthcare across different government levels, for-profit and non-profit providers, and numerous professions.
The study by Topp and colleagues also noted limitations in their approach, such as not including “primary health care” or “general practice” in their search terms for federal health workforce policies. These areas are gateways to other health services and fall within the federal government’s remit. The review’s focus on federal policy overlooks the significant role of state, territory, and private businesses in healthcare delivery.
Strategic Approaches and Future Directions
The patchwork of health workforce policies often responds to specific problems, but their effectiveness remains unclear. Rather than merely consolidating policies, a more strategic approach is needed. This involves understanding the challenges, determining necessary interventions, identifying responsible parties, and setting priorities. For instance, educational curriculum changes could foster interest in healthcare among students, while accessible training could encourage workforce entry and retention.
Reducing reliance on overseas recruitment is another critical aspect of sustaining Australia’s health workforce. Any new strategy should also consider its relationship with the broader care sector. The health workforce operates in an environment of rising costs, complex governance, and competing reform agendas. New policies must address these complexities and realistically assess achievable outcomes.
Ultimately, a robust policy framework is essential to overcoming barriers and ensuring the availability of health workers where needed. This will require resources, collaboration, and political will to navigate the intricate systems within healthcare and its interactions with other sectors.
