Health Workforce Study Combined Submission

This submission has been prepared from contributions made by members of the Pathology Associations Committee.  

Introduction

Pathology is integral to the practice of every area of medicine, and effective pathology services are crucial to maintaining high quality patient care.  Workforce shortages in pathology result in delayed test results, leaving patients waiting anxiously to know their diagnosis, and forcing clinicians to delay treatment or make treatment decisions based on incomplete information.  

Pathologist Workforce Crisis

A significant shortfall in the number of pathologists has been identified by the Australian Medical Workforce Advisory Committee.  A misdistribution has also been noted however the shortage is the most pressing issue ( see separate RCPA submission). Urgent efforts must be made to remedy this situation, as there is a long lead time for training people to fill the growing gap.

This shortage is an international problem.  As the situation worsens in other countries, it is conceivable that they will begin to recruit Australian trainees, further exacerbating local shortages.  It is imperative therefore that steps are taken to manage the problem in Australia.  

Scientist and Technical Staff Shortages

The shortage of pathologists cannot be addressed by simply reallocating tasks to other occupational groups.  Whilst there is very little meaningful data available on the medical laboratory science workforce (scientists and technical staff) in Australia, a number of problems are apparent.

Firstly, it is clear that the scientific workforce is ageing, with many expected to retire in the next ten years, and the numbers of graduate scientists and technical staff being recruited are insufficient to replace them.  Current graduate recruitment programs do not encourage entry into scientific fields, and State Governments in particular are no longer active in career planning and traineeships.  Furthermore, the continuing restructuring of the profession means there are relatively few positions for senior staff, and hence there is little succession planning for training more junior staff for the future.

One of the Scientific Associations reports that membership has fallen from 1213 in 1995 to 1021 in 2005, suggesting a drop in the number of scientists employed. This is the result of environmental drivers including amalgamation and downsizing of laboratories and the introduction of ‘simpler’ technologies. There has also been a general trend in major teaching hospitals to reduce in-house research. 

Most laboratories are currently unable to recruit sufficient staff to meet requirements. This is particularly true for junior scientists who provide out of hours and on call support. There is also a relatively high attrition rate of scientists in the early years of their career for the same reasons as other professions - a desire for better pay and more sociable work hours.  A high proportion of medical scientists are women, many of whom end up transferring to part time work or leave the workforce all together.  

There has been a distinct lack of workforce planning for the medical laboratory science workforce, and steps need to be taken to rectify this.  

Training Medical Scientists and Technical Staff

The environmental drivers outlined above coupled with the reduction in in-house research by hospitals have led to fewer sites where scientists can train, a trend which is also evident in the number of scientists presenting for examination.

There are several directed degree courses that prepare students for immediate employment in pathology laboratories, but some universities are having increasing difficulty implementing requirements for clinical placements.  Government assistance to fund clinical placements would be a valuable strategy to help address this problem.

Technical and scientific staff have in the past been able to undertake industry-specific training programs, however fewer traineeships combined with changes in the funding structure for Universities have led to the disappearance of these Graduate Diploma and Masters programs. As a result, the availability of qualified technical officers is dwindling, so that staff with basic scientific degrees but no specific medical laboratory training are being employed in technical roles.  This leads to high turnover, industrial tension and a less than harmonious work environment. 

Consideration could be given to alternative training opportunities.  In the United Kingdom, for example, shortages of pathologists have led to the development of training programs to for medical scientists.  The resultant Diplomas of Expert Practice give medical scientists the ability to assist pathologists in meeting clinical needs. 

Effect of Technology on Pathology 

The effects of changes in diagnostic technology on pathology practice are variable.  Whilst some advances may facilitate the transfer of additional tasks to other occupational groups if the requisite manpower is available, high quality medical input by specialised pathologists remains essential for the performance and interpretation of tests across all disciplines and technological advances may actually increase the requirement for pathologists.  For example, whereas breast cancer was once diagnosed using only a couple of slides, an anatomical pathologist may now review more than 50 slides in order to make a comprehensive diagnosis that will enable the patient to be given appropriately tailored treatment.   This level of examination is now considered fundamental by patients and clinicians, and there are obvious consequences for pathology workforce requirements.  

Other technological advances continue to create a range of alternative opportunities for enhancing support for the health workforce and improving patient care.  Telepathology, networked laboratories and virtual supervision are all examples of initiatives that would assist in the provision of pathology services to communities throughout Australia.  

Conclusion 

The community expects high quality medical care, and this is only possible with appropriately manned pathology services.  Effective workforce planning and resourcing is essential to ensure that the current crisis in pathology laboratory workforce groups can be redressed.