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Building and Sustaining an Appropriate Workforce

Professor David A Watters

RACS President

26th October 2015

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Building and sustaining an appropriate workforce

● What is the situation today?

● What do we want to achieve?

● How are we going to achieve it?

● What is appropriate?● How will we sustain

the workforce?

Photo: Katherine Edyvane

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Proportion of population without access to surgery

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An Appropriate Workforce Must Deliver

● Capability and Capacity

● Safety

● Affordability

● Timeliness 64% 40%58%

Three Bellwether Procedures

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Min 20 Surgery, Anaesthesia Obstetric Providers by 2030

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PNG - Anaesthesia Obstetric Providers by 2030

● Population – 8m● Surgeons (93 + 25)

■ 70 surgeons alive and working

■ 12 ENT, 11 Eye, 2 OMS

● Anaesthesia■ 25 Anaesthesiologists■ 20-25 Nurse anaesthetists

(ATO’s)

● Obstetricians: ■ 30 Diplomates■ 40 - MMed Specialists

PNG = 2.5-3.0 per 100,000

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Surgical Workforce in ANZ

Australia New Zealand

Poopulation 23.1m 4.3m

Registered Surgical Practitioners

5570 (4963) 859 (771)

Registered Anaesthetists

4627 (4163) 759 ( 624)

Registered O & G 1871 (1678) 289 (267)

Total trained SAO’s

12068 (10804) 1907 (1662)

SAO’s / 100,000 52.2 (46.7) 44.3 (38.6)

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Perioperative Mortality - Australia

  2009/10 2010/11 2011/12 2012/13

Australian Population*

22,031,750 22,340,024 22,728,254 23,129,299

Separations following surgical procedure 

902,582 921,072 944,308 952,993

Procedures per 100,000

4096.7 4123.0 4154.8 4120.3

Surgical mortalities

3,802 3,618 3,475 3,395

POMR (%) 0.421 0.393 0.368 0.356

Perioperative Mortality is death before discharge from HospitalNumber of patients who died after an admission episode (including day surgery) involving a procedure in an OR

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Training models for the SAO workforce

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The apprenticeship model – time based training

Time in Training plus a high stakes exit examination

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COMPETENCIES

Developed 2001, Trademarked 2005, Revised 2015

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9 competencies■ Medical Expertise■ Clinical Decision Making■ Technical Expertise■ Professionalism & Ethics■ Health Advocacy■ Communication■ Collaboration & Teamwork■ Management & Leadership■ Scholar and Teacher

RACS Competency Framework

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Competency Based Training

Multiple Workplace based Assessments – formativeSummative Assessments of Some Competencies- Decision Making and Clinical Expertise

Novice Intermediate ? Competent

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Is it Fit for Purpose?

Agree Standards Measure & Report Progress

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Training other health workers

● Extending scope of practice● Nurse anaesthetists – support anaesthetic and

surgical care in many countries of this region● Clinical officers in Sub-Saharan Africa are

trained to do surgical procedures● Medical Officers trained to do Caesarean

Sections and other procedures● Training doctors and others for rural or remote

practice

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Six Principles for Extended Scope of Practice

Phil Carson & RACS 2015

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Brain Drain – The Push and Pull Factors

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Brain Drain – Your country needs you?

But do they make you feel it and look after you?

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3R’s for Sustaining the Workforce

● Renewal: Engaging them in life-long learning as a principle of practice

● Recognition – career opportunities and recognition within the health system

● Reward – A salary structure that rewards the healthworkforce

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Universal access to safe, affordable surgical & anesthesia carewhen needed