Careers of South Australian health professional graduates.

• Author: Carson, Ed
• Position: Contributed Article

Abstract

In fight of continuing debates about shortages in health professional workforce& and decisions over the past few years to increase the number of medical, dental and physiotherapy schools across Australia, this paper reports on a study of the careers of medical, dental and physiotherapy graduates from South Australian universities from 1960 to 2003. We found substantial change over time, including recent graduate cohorts having proportionally more females and fewer having attended a private secondary school A significant minority reported job dissatisfaction and burnout, with recent cohorts reporting higher levels of stress than older respondents. They were also working part-time more than was the case for older cohorts at equivalent points in their careers. We argue that strategies to increase graduate numbers in the near future can reduce shortages of health professionals, but increased numbers alone may not be sufficient to promote a sustainable health professional workforce.

Introduction: Caps and Cycles in Health Workforce Planning

Reports of a crisis in the supply of medical and dental practitioners have appeared regularly in recent years, with the common theme that recruitment and retention constitute serious problems for service delivery in a broad range of health settings (DOHA2008; Australian Health Minister's Conference 2004; Productivity Commission 2005; COAG 2006, Joyce and McNeil 2006; Access Economics 2002; Conn et al 2001). There are long lead times involved in increased intakes in health professional training flowing into the health workforce, but from 2008 onwards we can begin to see the effect of recent growth in University schools and places for these professions in Australia.

After a period during the 1980s and 1990s when growth was capped, since 2000 the number of medical schools in Australia has doubled. The full effects of increased numbers of schools and places will not be evident until 2012 onwards, but total graduates in 2012 will be double the number of graduates at the beginning of this expansionary phase--some 3000 annually from 2012 onwards compared to less than 1500 annually in 2000 (Joyce et al 2007).

While the scale of expansion in numbers of medical practitioners is not matched by planned supply of dentists there are nonetheless parallels in the dental training arena. Three new programs have opened in the past five years in Queensland and Victoria, bringing the current number to eight dental schools, and they are about to contribute to increased national output. But even with increased numbers of graduates, recent concerns about locational imbalance, and especially rural shortages, look set to continue. Debates about location of the schools highlight competing principles of allocation, including a contrast between population growth projections in Queensland and Victoria compared to compensation for under representation in the past (Tasmania continues to have no dental school and has the lowest number of practising dentists per 100,000 people [AIHW 2008]).

Similarly, the number of University physiotherapy programs nationally has grown in the last 15 years from five to now 18 and the type of entry level qualification has diversified. As a result, graduate numbers have almost doubled and will continue to increase as five new programs are in the process of being developed in Queensland, Victoria, Western Australia and Northern Territory.

It can be expected that recent shortages of health professionals will be redressed by this trend. There are, however, questions about whether projected completion rates of those embarking on the training will change from current experience and, more importantly, whether changes in the characteristics of students will influence deployment, work participation and career choices of the graduates.

Documenting Work and Workforce Change

Both in Australia and overseas there have been calls for an understanding of the changing nature of work for medical practitioners and how these changes will impact on the future supply of services (DOHA 2001; Strasser et al 2000; Davidson, Lambert and Goldacre 1998; Goldacre 1998; Lawson, Armstrong and van der Weyden 1998; Allen 2000; 1996; EPAC 1996; Parkhouse 1991). Equally important, although not as well publicised, is an emerging concern about the sustainability of the professional workforce in a broader range of health occupations (Australian Health Minister's Conference 2007; Productivity Commission 2005; COAG 2006).

The development of health workforce policy needs to be informed by research on employment participation, career patterns and the varying experiences of a range of health professionals including medical practitioners, dentists, nurses and allied health professionals (AMWAC 1998; DoHA 2001; Access Economics 2002; Australian Health Ministers' Conference 2004; Spencer AJ et al 2003; Joyce, McNeil and Stoelwinder 2004; Hays 2002; Pringle 1998). Of particular concern in Australia is a need to document the geographic distribution of health professionals in outer metropolitan, rural and remote regions (AMWAC, 1998; DHAC, 2001; Access Economics, 2002; Australian Health Ministers' Conference, 2004).

In addition to media coverage and official reports, there are lively debates in the scholarly literature about the extent to which the workforce participation and work experience of health professionals has changed over time because of the changing composition of the workforce, as well as the organisation of health service delivery. At least two aspects dominate these debates. First, they concern whether growth in the workforce is best achieved by training more professionals or by deploying professionals more effectively than at present. This is partly a question about the implications of demographic changes for workforce participation and career patterns, including the influx of women into medical and dental professions and the influx of men into physiotherapy. Second, they concern the extent to which stress, burnout and occupational health considerations are altering satisfaction with work and have possible implications for workforce participation, including premature exit from the workforce.

These debates in the scholarly literature provide a context for findings from a survey of the workforce participation and employment experience of medical practitioners, dentists and physiotherapists who graduated from South Australian universities from 1960 to 2003. In particular, the study compares the workforce participation and employment experiences of health professionals from different graduate cohorts, for each profession and separately for male and female graduates, to identify the implications of changes in career paths for health workforce policy.

Methodology

The main method of data collection in this study was a mailed self-administered questionnaire completed in 2005 by doctors, dentists and physiotherapists who graduated from South Australian Universities over a forty-year period from 1960 onwards. Table 1 shows the total number of graduates from South Australian Universities over that period, the sample that was used and the number of responses received.

For this survey, non-response error was minimised by utilising well-established procedures outlined by Dillman (2000). Measurement error was minimised by use of questions based on existing, validated items, drawn where possible from the literature. The sampling frame was generated by using lists of graduates rather than using only professional registers, to include those who had left professional practice, and sampling frame error was reduced by extensive searching of professional registers, telephone directories and the Internet. The survey achieved a response rate of 56 per cent.

In addition to collecting demographic data from respondents, major components of the survey questionnaire included the respondent's current practice activity (including hours worked) and the completion of a chart that detailed workforce participation over the period since graduation. In addition, it was highlighted in the questionnaire that working in their graduating profession 'includes general, specialist and restricted practice, as well as administration, teaching and research'. In the chart, respondents were asked to separate (for each year since graduation) their workforce participation into: full- and part- time work in South Australia and interstate from South Australia, overseas working in and not in their graduation profession, retired from regular work and not working. Full-time was defined as an average of 35 or more hours per week. While there are risks associated with relying on the retrospective recall of respondents, there is sufficient support in the literature for the use of this methodology when it is designed to elicit information on important events relevant to the respondents, and associated with career milestones (Peters 1988).

Other components of the questionnaire used Likert scales to elicit reactions to a series of attitudinal statements on career choice, professional expectations, job satisfaction and stress. These questions were complemented by open-ended questions that sought additional information on the issues, and such information was provided by 92 per cent of the survey respondents. In addition, two focus groups were convened, with one consisting of female only graduates across the three professions and one consisting specifically of medical graduates.

Analysis of the data was undertaken using SPSS Version 15.0 for Windows. The data were weighted by the total number of graduates in each cohort for each profession. For the analysis of career choice for men and women, logistic regression (using the backward stepwise method and likelihood ratio procedure to remove variables from the model) was used separately for each profession (Spicer 2004). Each model included as independent variables the secondary schooling characteristics...