The physio will see you now. Why health workers need to expand their roles to solve the workforce crisis

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This article is part of The Conversation series on the Labor Jobs Summit. Read the other articles in the series here.


Australia’s biggest workforce challenge is health, an issue that will likely stay with us for another decade.

Health worker shortages reduce access to care, increase wait times and reduce patient safety. They can even increase preventable deaths.

However, we don’t need the next Jobs and Skills Summit to resolve this problem. There are already fruits within reach to pick.

We need to expand the scope of practice for some health workers, engage in better workforce planning, and reform how existing and new resources are deployed.



Read more: General medicine is in trouble. Here are 5 lessons from overseas to reform the financing system


Health workers burn out and leave

Exhausted health workers leaving the labor market are a key factor in the increase Jobs across Australia.

Although largely due to the unprecedented nature of COVID, Australia has had problems staffing its healthcare system for years. The labor shortage is particularly acute in rural and remote areas.

The natural response is to throw money at the problem, but the Australian government has little money in reserve. Its budget deficit is expected to be greater than 800 billion Australian dollars by 2025-26. State governments are also strapped for cash.

Greater immigration of skilled health workers may also have limited success. Australia will compete with countries like New Zealand, Canada, the United States and the United Kingdom, which are looking to provide their own health worker shortages.



Read more: Despite what political leaders say, New Zealand’s healthcare workforce is in crisis – but it’s the same everywhere else


Health workers could take on more roles

Registration of health workers, as well as standards and protocols, are essential to ensure safe and effective care. However, it also prevents health workers from taking on new roles usually taken on by others.

The possibility of expanding the roles of health workers was discussed during more than two decades. There has been progress. Pharmacists now administer some vaccines, which was traditionally the domain of general practitioners and nurses.

Pharmacists now administer some vaccines, once the domain of GPs and nurses.
Victor Joly/Shutterstock

An expanded scope of practice for some health workers can increase people’s access to care, create greater job satisfaction for health workers and lead to more effective health care. It could also help the healthcare system respond better and faster to future pandemics or large-scale reform.

Overall, advanced organizations and specialized colleges have effectively protected their territory. This may have resulted more expensive care for the public and the government because it prevented cheaper health workers from providing care.

We are now faced with a more serious problem. A wider scope of practice for some health workers is needed to ensure timely access to care. This stronger message will help the government through future turf wars.



Read more: How rivalries between doctors and pharmacists turned into the ‘turf war’ we see today


New roles for paramedics, pharmacists and physios

Health workers in other countries are increasingly flexible in the scope of the tasks they perform.

The UK National Health Service has ‘expanded roles’, such as nurses being more involved in chronic disease management. There are also “advanced roles”, which require an advanced practice proficiency. An example is allowing advanced nurse practitioners to manage people with mental health issues in the community, under the direction of a psychiatrist.

Australia is also starting to think differently. The decennial National Medical Workforce Strategy published in 2021 aims to rebalance sub-specialization towards a more generalist workforce to improve access to care. The hope is to create more general practitioners and specialists with additional skills, such as emergency care, and other selected specialist skills.

There are opportunities to expand the role of paramedics, especially in rural and remote areas where there are not enough GPs and nurses.

Paramedics have evolved from emergency care delivery to chronic disease management, mental health and social care. Additional paramedic training to understand diagnostic tests, prescribe certain medications, and care for wounds could increase patients’ access to health care.

Physiotherapists could be the first point of contact for musculoskeletal disorders. They could inject steroids and refer patients to orthopedic specialists.

Pharmacists could also play a bigger role, dispensing drugs without a prescription rather than requiring a prescription from GPs.

Sexual health is one area. Allowing women to have access to the oral contraceptive pill without a prescription would profitable with minimal risk. Viagra requires a prescription in Australia but is sold without a prescription United Kingdom.

How do we fund this?

Any health workforce reform to address shortages must ensure that quality and safety are maintained and provide a patient experience that is at least as good as current practice.

It must also be accompanied by favorable financing models.

Nurse practitioners are a good example. They were introduced to Australia in 1998 to fill physician shortages, allowing registered nurses with additional training to diagnose, perform procedures, and prescribe medications – within tightly defined parameters.

Today, more nurse practitioners work in public health, particularly in emergency departments.

More and more nurse practitioners are not in private practice for a number of reasons, including Restricted Medicare and Pharmacy item numbers.

With appropriate funding models, expanding the roles of nurse practitioners could significantly increase access to care and reduce healthcare costs.



Read more: Australia could do so much more with its nurse practitioners


We need better planning

Health workforce shortages are an endemic, multifaceted and cross-jurisdictional problem. COVID has amplified shortages, but poor planning and limited government investment are mainly to blame.

There is a shortage of specialists in some areas and an overabundance of specialists in others. Redistribute the health workforce, from metropolitan to rural and remote areas, would fill some shortages.

Australia also needs another independent agency such as Health Workforce Australia. It was established to support workforce reform initiatives in 2009, but phased out in 2014.

The roles of a new agency should include independently identifying workforce needs across the health system, helping to coordinate investments in education and training, and providing evidence to broaden the reach, retention and reform of the workforce.

What policies would we need?

The health system must also reform to reduce waste and redeploy precious resources more efficiently.

Digital health and other technological advancements offer opportunities to improve productivity in the workplace, alongside the reorganization of models of care.

Reducing bureaucracy and better allocating administrative tasks to non-clinical staff can also free up more time for clinical care.

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