Members Update | Workforce And Members Wellbeing

Calls for SIMG Pathway, Scope of Practice Review & health system reform-Council of President of Medical Colleges (CPMC) and Specialist Medical Societies Executive Meeting 14 February 2025

Professor Phil Parente represented MOGA at this special meeting between the Specialist Societies and the CPMC to consider critical issues currently under consideration and implementation by governments that will significantly impact our healthcare system.

These include potential changes to the expedited Specialist International Medical Graduate (SIMG) pathway and the Scope of Practice review, which will affect all specialities.

While CPMC strongly supports efforts to address workforce maldistribution, evidence indicates the changes now operating risk creating a two-tier healthcare system without addressing fundamental distribution challenges.

The Medical Colleges are united in supporting international medical graduates as they are important to our system, however, there is a need for sustainable solutions.

The CPMC’s national Advocacy Campaign focuses on the following issues.

      · Expedited SIMG Pathway concerns

      · Scope of Practice Review concerns

      · Key Asks for both issues and health system reform in general including:

• Mandatory rural and regional service periods for all SIMGs processed through the expedited pathway, with robust enforcement mechanisms

• Extension of SIMG supervision requirements from 6 to 12 months

• Halting the expansion of expedited SIMG pathways and limiting acceptance of qualifications from additional countries

• Accrediting SIMGs based on their last three years of experience

• Establishment of a joint Federal Government-College working group to oversee the SIMG pathway

Royal Australasian College of Physicians’ (RACP) Workforce and Member Wellbeing Advocacy

Executive Member and NOMP (National Oncology Mentorship Program) Lead, Dr Jenny Liu, represented MOGA at the NSW/ACT RACP Workforce and Member Wellbeing Advocacy Focus Group on November 25.

As part of members’ engagement and support activities Focus Group sessions have now been held in all jurisdictions across Australia. The College has approved the following high-level workforce advocacy focus areas:

· Workforce attraction and retention

· Member wellbeing and daily practice challenges

· Regional, rural and remote workforce

The existing focus on the Indigenous workforce will also continue to be an advocacy priority.

Work is now in play refining an advocacy plan and asks for national advocacy efforts to continue alongside tailored advocacy through state and territory committees to address local workforce challenges.

The discussions highlighted key issues such as insufficient administrative support and increased clinician workload and burnout, particularly in fractional roles. Limited training and mentorship opportunities, especially in rural areas, and a lack of flexibility in training pathways.

The rise in fractional roles and insufficient financial incentives were identified as contributing to workforce instability. There is a need to increase administrative support, provide flexible roles, enhance mentorship and training opportunities through the provision of protected teaching and learning time, improve rural healthcare opportunities, and revise workforce funding models.

This feedback will be used in ongoing efforts to improve member workforce wellbeing. This will involve continued advocacy for essential policy reforms to address workforce challenges, improve training flexibility, and enhance support systems for trainees and Fellows.

Royal Australasian College of Physicians’ (RACP) Workforce and Member Wellbeing Advocacy Focus Group: Discussion points and recommendations (25 Feb 2025)

Workload and Workforce Wellbeing

• Insufficient administrative support: Growing administrative requirements, including from the College, are adding to clinicians' workloads. Insufficient administrative support creates additional strain on clinical staff.

• Burnout, stress and low morale: Many healthcare professionals, especially those in fractional roles, are experiencing burnout, stress and low morale due to excessive workloads, lack of support and mentorship, and the pressure of administrative tasks. Many tasks, such as follow-ups, and paperwork, are not reimbursed but consume significant time.

• Bullying: Participants identified bullying as contributing to increased stress, burnout and professional dissatisfaction.

• Workforce shortages in particular specialties: Workforce shortages in particular specialities, such as chemical pathologists and paediatrics.

Training, Supervision, and Professional Development

• Rural and Remote Areas: There are insufficient training and supervision opportunities in remote and rural areas.

• Flexibility in Training Pathways: The current workforce model lacks flexibility, making it difficult for trainees to access accredited positions or engage in different specialties.

• Insufficient Protected Time for Teaching and Learning: Many clinicians face challenges in securing dedicated time for teaching, learning, research and supervision, impacting training quality.

• Lack of Formal Mentorship: There is a significant gap in structured mentorship, particularly in specialties like paediatrics, where professionals are isolated and lack adequate support.

• Peer review challenges: Peer review challenges were highlighted in the ACT in situations where both parties are overseas trained.

Fractional Employment and Workforce Flexibility

• Rise in Fractional Roles: The increase in fractional positions, driven by financial constraints and lifestyle preferences, is creating workforce instability and challenges in maintaining sufficient full-time staff.

• Lack of Financial Incentives: Many specialists prefer fractional roles or private practice due to the lack of financial incentives in full-time positions.

• Limited Job Opportunities: The demand for flexible roles is high, but there are insufficient permanent positions, particularly in regional and rural areas.

• Increase in Locums and Temporary Staff: There has been an increase in locum work and temporary staffing arrangements, eroding the permanent workforce.

Challenges in Rural and Regional Areas

• Workforce Distribution in Rural Areas: Many professionals avoid working in rural and remote areas due to limited resources, family support, and career opportunities.

• Workforce Requirements Data Mapping: There needs to be better data mapping about our workforce requirements. Eg., if Australia introduces Physician Assistants, they may predominantly want to work in metropolitan areas, which won’t address rural, regional and remote healthcare workforce shortage.

• Difficulty Accessing Accredited Training: Trainees in rural areas struggle to access accredited positions due to lack of supervision and limited training resources.

• Lack of Flexibility in Training Locations: The inflexible STP system limits opportunities for trainees to explore different regions or specialties, hindering workforce distribution.

Financial and Structural Issues

• Funding and Resource Allocation: Funding models often don’t account for the time and support needed for adequate mentorship and teaching, leaving limited resources for training, supervision, and workforce support.

Financial compensation for roles like fractional work is often insufficient to cover the full cost of a consultant, leading to dissatisfaction.

• Healthcare model: The delivery of healthcare has increasingly shifted toward a service industry model placing significant pressure on frontline healthcare workers including physicians. As patient demographics become more complex, financial constraints can make it difficult to equitably assist marginalised populations.

• Lack of physician representation in leadership: Healthcare organisations may lack sufficient physician representation in executive or senior leadership positions, which can impact patients.

• Technology: The high cost of digital health infrastructure is consuming a large portion of healthcare funding, but there is still no widespread integration of IT systems, which would benefit patients and physicians.

Recommendations:

• Increase Administrative Support to alleviate clinician workload.

• Enhance Workforce Flexibility and address fractionalisation by offering flexible positions and accredited training positions to reduce burnout and support work-life balance.

• Support Training and Teaching by ensuring teaching and learning time is protected (including through the accreditation process) and through enhanced mentorship opportunities.

• Enhance Rural Training Opportunities through increased funding and flexibility for regional and rural training programs (including the STP program), improved infrastructure, and better support for healthcare workers in underserved areas to improve workforce distribution and retention.

• Revise Workforce Funding Models to account for the time and resources needed for the provision of effective mentorship, teaching, and supervision in healthcare.

• Improve IT Systems to make them more standardised and effective for physicians and patients.

• Advocate for Governments to Engage with Frontline Workers about developing solutions to healthcare workforce and wellbeing issues.

• College to advocate for improved workforce and wellbeing conditions for physicians.