ARA progresses workforce issues following key report

4 minute read

After releasing a report earlier this year advocating for more rheumatologists, the ARA outlined key steps of progress towards action.

On the final day of the 2023 ARA ASM, Professor Catherine Hill presented a recap of the 2021 workforce survey findings and outlined what’s happened since then.

The good news is that there have already been commitments from some state governments to address workforce shortages and service maldistribution, with initiatives at the trainee selection level and measures to reduce administrative workloads also in the pipeline.

The workforce survey was completed by about 80% of ARA members in 2021. The results were presented at the 2022 ARA ASM with the report released in February this year.

In short, it found that Australia has an undersupply of both adult and paediatric rheumatologists, and on current trends this shortage is likely to worsen due to an ageing workforce, a large number of rheumatologists planning to reduce workload in the short-term and a tendency for younger rheums to work fewer clinical hours.

While the shortages vary from state to state, rural and regional areas are most at risk of undersupply due to a reliance on older rheumatologists.

The ARA has been advocating to improve the situation and continues to do so. After sending the report to stakeholders including federal and state health ministers and their opposition counterparts, the RACP and Arthritis Australia, the ARA has met with representatives of most jurisdictions.

The briefing documents, which were individualised to each state, covered the need for an increased number of rheumatologists by increasing the number of advanced training physicians; an increased number of rheumatology physicians in public hospitals to allow access to more affordable care; initiatives to increase job satisfaction and reduce burnout; to explore the impact of increased access to rheumatology nurses and nurse practitioners to reduce workload; funding for rural chronic inflammatory nurses to support rural patients with inflammatory conditions requiring biologic agents; and increased support for rural rheumatology positions.

“We also strongly advocated for Recommendation 1 of the Parliamentary inquiry into the childhood rheumatic diseases interim report, which recognises the limited number of paediatric rheumatology specialists, and requested urgent establishment of an eight-year program of secure funding to provide fellowships and training programs in paediatric rheumatology,” said Professor Hill.

Federal Department of Health and Ageing secretary Professor Brendan Murphy reported that the STP program is currently under revision, and he recommended approaching federal health minister Mark Butler regarding a pilot of multidisciplinary team care in private practice and a pilot of a chronic inflammatory nurse program.

The rural chronic inflammatory nurse program is a model that was proposed by the Crohn’s & Colitis Australia consumer group.

“We participated in that, and we did actually do some advocacy with the previous government around that, but this probably needs to be proposed again,” said Professor Hill.

“I think it’s a good model for helping rural patients to have access to a nurse who could help them with the biologics, and it wouldn’t just be rheumatology – it would probably be rheumatology, gastro and dermatology.”

Mindful of the fact that rheumatology is currently in outpatient specialty, and getting missed in national hospital funding agreements, Professor Murphy also recommended raising with Mr Butler the need for discussions with Mike Walsh, who’s reviewing the national hospital funding agreement, with regard to funding positions with an outpatient focus.

Professor Hill presented early outcomes from some states.

The Queensland government has said it will undertake a modelling exercise, with ARA involvement, on the private and public workforce to model future requirements by location. It will also “confirm the service need which will inform the model of care and subsequent workforce planning”.

The NSW ministry of health said it was working on the paediatric rheumatology component with Dr Davinder Singh Grewal in the next few weeks.

Lobbying prior to the last state election in South Australia resulted in two new advanced training positions – one adult and one paediatric.

Other measures that may help with rheumatology workforce issues, said Professor Hill, were the proposed Medicare reforms, while new initiatives in digital health may help with workload.

“Further steps are advanced training selection to optimise selection of trainees to areas of need, further advocacy regarding paediatric training positions and rural and remote training, and reducing admin workload,” said Professor Hill.

“And Claire [Barrett] has met with the Department of Health to ensure implementation of PBS changes to increase streamlining for paediatric biological prescriptions and adult biological prescriptions, which will take workload off us as well.”

Professor Hill finished by suggesting that in the future the ARA should conduct workforce surveys every three years, providing a “barometer” of the rheumatology workforce in Australia.

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