Augmenting the rural health workforce with physician assistants

Health workforce shortages are a global phenomenon and Australia is no exception. Deficiencies are particularly pronounced in general practice, dentistry, nursing and key allied health fields. Even with the Australian health workforce growing at close to double the rate of the population and despite an increase in medical schools and student numbers, the shortage continues to worsen due to factors such as reductions in work hours, increasing urbanisation and the ageing and feminisation of the workforce. A 2005 prediction by the Australian Medical Workforce Advisory Committee estimated a shortage of between 800 and 1300 general practitioner graduates alone by 2013. The ageing of the health workforce, increasing life expectancy and the mounting burden of chronic disease are major problems facing all developed nations. Compounding these issues in Australia are the difficulties of caring for significant rural, remote, and Indigenous populations. National and international trends suggest that the shortage and maldistribution of doctors in rural areas is very likely to worsen. As well, Australia has an increasing reliance on international medical graduates, which poses major moral questions among other dilemmas. Clearly there is a need for change in policy and service delivery models. Simply increasing the number of doctors will not necessarily improve recruitment or retention in general practice and geographically disadvantaged areas. According to Queensland Health there is considerable and ongoing difficulty in recruiting new doctors to rural and remote locations, resulting in a less than adequate rate of replacement for retiring doctors. Many health care advocates and organisations have suggested a variety of innovations to facilitate the needed transformation in the existing system. In 2007 The National Rural Health Alliance (NRHA) declared: