Imagine launching a sailing boat in Sydney, setting the compass for Vancouver and then sitting back with a Gin & Tonic expecting to arrive at your chosen destination on time!
Predicting a future outcome without adjustment along the way is a risky undertaking for anyone that puts a high value on being right. Medical workforce planning is notoriously hard to get right because of lengthy lead times and the multiple variables that are involved.
Yet based on demographic predictions, the past decade has seen Australia boldly increase its medical graduate numbers by over 80% in an attempt to address a projected workforce shortfall. In the late 1990’s an “opinion” that the Australian medical workforce was over-supplied was suddenly inverted – an about-face that is hard to reconcile with the principles of rigorous scientific projection.
The subsequent over-compensation in medical school numbers has seen the first wave of new graduates spilling out of universities in 2011. Like the post war baby-boomers they have already proven to be a somewhat indigestible cohort to those involved in the actual employment and training of doctors and will no doubt continue to cause headaches as they progress up the career ladder.
Australia could learn a lot from the British experience, which has not really settled since the Calman Report triggered sweeping changes to the way doctor's careers were structured. This led to all sorts of unintended consequences - mainly bottlenecks in certain specialties, deficits in others. Its successor, Managing Medical Careers has yet to fulfill the promise of resolving some of the earlier oversights, highlighting the risks of tinkering with complex systems.
Given our interest in medical worforce issues we also gaze into our crystal ball from time to time to try to anticipate supply and demand issues in the future. I used to think in terms of a 15-year time horizon for medical workforce planning (graduation to specialization) until I met a medical school planner who worked on a 30-year planning cycle. How had I missed it? Of course - 5 years to decide there is a problem, 5 years to create medical school places and 5 years to complete the undergraduate training – then the graduate years.
So who can accurately predict what the medical landscape in Australia will look like in 30 years time (2042 at time of writing)? It’s a tall order. Population numbers are probably the most reliable statistic, yet I have seen projections everywhere from 25-45 million. Things start to get increasingly wobbly after that. Throw in complexity of medical technology; political situations; international workforce pressures; demographics of the medical workforce etc. and things start to go seriously awry.
Like our sailor setting out for Vancouver we won’t be far out from port before we need to re-assess and trim the sails accordingly. We will all, no doubt, get to the future but it is unlikely to look anything like we expected.
The implications of accurate predictions for patients, medical graduates, governments and taxpayers are huge. Time alone will tell if the dramatic increase in medical school numbers is: a gross over reaction leading to a glut of doctors; too little too late; or right on the money. I personally suspect that the chances of the current and proposed graduate numbers being just right are somewhere shy of a snowball’s chances in hell.