Is the national doctor shortage a myth?

The recent rise in the number of GPs could be welcomed as addressing the shortage. Image from shutterstock.com

Monash University demographer Bob Birrell is quoted in today’s Australian newspaper as saying the national doctor shortage is “a myth”. He points out a large recent increase in the number of GPs, a rise in the service rate per person and suggests GPs are over-servicing patients.

But a closer look at the interpretation of the data in the article reveals some flaws.

The first question is whether a recent rise in the number of GPs – and the service rate – indicates Australia is not experiencing a doctor shortage. It doesn’t. Estimating whether a shortage exists depends on an estimate of the needs (or “demand”) for GP services for a given population. So simply relying on supply data alone (the number of GPs or the number of services provided) cannot prove the existence, or otherwise, of a shortage.

Given the previous estimates of a shortage, the recent rise in the number of GPs could be welcomed as addressing the shortage. It’s incredibly difficult to measure shortages and surpluses, as it requires a whole host of indicators and judgements, so it remains unclear when the current growth in GP supply will represent a surplus.

As to whether GPs are over-servicing their patients, the data in Birrell’s analysis does not present a convincing picture. The rise in the service rate could equally represent previously unmet need being met. According to the 2009 ABS patient experience survey 6% of adult Australians (1.1 million) delayed seeing a GP or did not see a GP because of cost.

Further research in this area is necessary to ascertain the relationships between patient needs and the GP services provided in the market: it’s difficult to define over-servicing without knowledge about what the “right” level of servicing is.

There could be other reasons why an increase in the supply of primary care could benefit the population and could even reduce health-care costs overall.

First, as noted in the Australian article, extra GPs in the market will generally keep prices down, and bulk-billing rates up. This will have benefits to patients and to the government, which may face less pressure to increase the level of Medicare payments.

Second, two key roles of GPs are in prevention (lifestyle advice, smoking cessation, vaccination) and treating chronic disease (such as diabetes, hypertension, depression) both of which can keep patients out of expensive hospitals. So an increase in primary care supply could reduce overall health-care costs.

We agree that the rapid increase in medical training places, a feature of politically-fuelled “boom-bust” nature of health workforce investment, is posing challenges for the sector. The system is struggling to find employment for these new graduates, and policymakers are investigating reduced immigration of doctors so domestically trained graduates can fill these jobs.

Rapid expansions and contractions in the growth of the health workforce occur about every 15 years and are usually politically driven. In the past, decisions on whether to train more doctors have ignored the costs and benefits of doing so. Training costs are often borne by the states and territories, making it easy for federal politicians to make these “boom and bust” announcements.

Dr Birrell is correct that the current increase in doctors provides a one-off opportunity to distribute those doctors to specialisations, sectors, and geographic areas where health-care needs are highest. Addressing the current maldistribution of doctors will be the challenge of health workforce policy in the coming years.