minimum data set report and workforce - rural health west

Minimum Data Set Report and Workforce Analysis Update November 2012

Published May 2013

Photo courtesy Dr Tony Tropiano – Harvest Time.

Rural Health West

This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part of this report may be reproduced without prior written permission from Rural Health West. Enquiries concerning rights and reproduction should be directed to Rural Health West, PO Box 433, Nedlands Western Australia 6909.

Suggested citation

Rural Health West (2012). Minimum Data Set Report and Workforce Analysis Update: 30 November 2012. Perth: Rural Health West

Limitations

Rural Health West acknowledges there are limitations with data collection for various reasons. Data specific to doctors who provide primary care services to country hospitals may be under represented.

The information in this report was current at the census date of 30 November 2012.

Website

www.ruralhealthwest.com.au

Compiled by

Rosalie Wharton – Data Coordinator, Rural Health West Sally Congdon – Manager Special Projects, Rural Health West

Acknowledgements

Rural Health West thanks all rural and remote general practitioners and general practice staff in Western Australia, WA Country Health Service, Western Australian General Practice Education and Training Limited, Medicare Locals, GP Networks, Aboriginal Medical Services and others for their support and contributions in providing and validating the data used in this report.

Rural Health West’s recruitment and retention activities are primarily funded by the Australian Government Department of Health and Ageing and the Western Australian Department of Health, WA Country Health Service.

May 2013

Rural Health West | Minimum Data Set Report and Workforce Analysis Update 2012 | TRIM D13/43631 1

www.ruralhealthwest.com.au

Table of contents

1. Introduction 5

2. Executive Summary 6

3. Data collection and analysis strategies 9

4. Demographics of GP workforce as at 30 November 2012 10

Models of service provision 10

GPs by age and gender 11

Average age of all GPs 11

GPs by age group and gender 12

GP numbers by location 14

GP numbers by Remoteness Area 14

GP numbers by Medicare Local 15

5. Changes in the permanent GP workforce 16

Overall GP workforce turnover 16

GP workforce changes by gender 18

GP workforce changes by Remoteness Area 20

GP workforce changes by age group 22

6. Clinical workloads 23

Average hours worked per week 24

Average hours by gender and age group 25

Full-time and part-time workloads 26

Average hours worked per week by Remoteness Area 27

7. Length of employment in current principal practice 28

Average length of employment 28

Average length of employment by Remoteness Area 29

8. Practice type 30

9. GP proceduralists 31

Number of GP proceduralists 31

GP proceduralists by gender 33

GP proceduralists by age 35

10. Country of training and residency 36

Country of training 36

Residency 38

11. GP registrars 39

12. Aboriginal Medical Service practices 42

2 TRIM D13/43631 | Minimum Data Set Report and Workforce Analysis Update 2012 | Rural Health West

List of tables

Table 1 GP numbers by primary model of service provision 2011 v 2012 10

Table 4 GP turnover November 2011 to November 2012 16 (excluding WAGPET GP registrars)

(excluding WAGPET GP registrars)


in 2012 by Remoteness Area


(excluding WACHS hospitals)

Table 16 Residency status of GP workforce 30 November 2012 38

Table 2 GP numbers by Remoteness Area 14

Table 3 GP numbers by Medicare Local boundaries 2011 v 2012 15

Table 5 Destinations of departing GPs 2011 v 2012 17

Table 6 Origins of GPs joining the workforce 2011 v 2012 17

Table 7 Changes in GP workforce by gender 2011 to 2012 18

Table 8 Changes in GP workforce by Remoteness Area 2011 v 2012 20

Table 9 Destinations of GPs who departed rural Western Australia 21

Table 10 Changes in GP numbers by age group 2011 to 2012 22

Table 11 Comparison between part-time and full-time workloads by gender 26

Table 12 Part-time workforce by gender 2011 v 2012 26

Table 13 Number of GPs by practice type by Remoteness Area 30

Table 14 Number of practices per Remoteness Area 30

Table 15 Numbers and proportions of GPs practising procedures 2011 v 2012 31

Table 17 Residency status of doctors on the Five Year Overseas 38 Trained Doctors Scheme 2011 v 2012


List of figures

Figure 1 Average age of GP workforce 2001 to 2012 11

Figure 2 Composition of the GP workforce by ten-year age group and gender 12 as at 30 November 2012

Figure 3 Number of GPs by gender and percentage of female GPs 2003 to 2012 13

Figure 4 GP turnover rates by gender 2004 to 2012 (excluding WAGPET GP registrars) 19

Figure 5 Average hours worked per week from 2006 to 2012 24

Figure 6 Average hours worked per week by gender and ten-year age groups 25

Figure 7 Average hours per week by Remoteness Area 27

Figure 8 Length of employment in current principal practice 28 (excluding WAGPET GP registrars)

Figure 9 Length of employment in current principal practice by Remoteness Area 29

Figure 10 Numbers of GPs undertaking procedural work 31

Figure 11 Number and proportions of GP proceduralists 2005 to 2012 32

Figure 12 Number of GP proceduralists by gender 2012 33

Figure 13 Number of female GP proceduralists between 2006 to 2012 34

Figure 14 Average age of GP proceduralists 2006 to 2012 35

Figure 15 Number and percentage of International Medical Graduates 2005 to 2012 36

Figure 16 Country of basic medical qualification (non Australian trained doctors) 37

Figure 17 Total number of GP registrars 2002 to 2012 39

Figure 18 Average age of GP registrars 2002 to 2012 40

Figure 19 Number and proportion of overseas trained GP registrars 2003 to 2012 41

Figure 20 Number of GPs in Aboriginal Medical Service practices v overall 42 2002 to 2012

Figure 21 Average age of GPs in Aboriginal Medical Service practices v overall 43 2002 to 2012

Figure 22 Percentage of International Medical Graduates in Aboriginal 44 Medical Service practices v overall 2002 to 2012

Figure 23 Comparison between turnover in Aboriginal Medical Service 45 practices v overall 2003 to 2012

Figure 24 Percentage of female GPs in Aboriginal Medical Service practices 46 v overall 2002 to 2012


1. Introduction

The core mission of Rural Health West is to attract, recruit and retain the rural health workforce; and to gather evidence to plan for future workforce requirements. Rural Health West maintains an up-to-date database of the medical workforce in Remoteness Area 2 to 5 locations in Western Australia. This database is updated each year through general practitioner and general practice surveys and a variety of other ongoing strategies. The data is collated, de-identified and then compiled into a detailed annual report entitled the Minimum Data Set Report and Workforce Analysis Update (MDS Report).

Historically, the locations for which data was collected were those defined as Rural, Remote and Metropolitan Area (RRMA) classifications four to seven. In July 2010, a new remoteness classification was introduced, the Australian Standard Geographical Classification (ASGC) Remoteness Areas (RA) system which replaced the RRMA classification system. Rural Workforce Agencies now collect workforce data for RA 2 to RA 5 locations.1 The RA categories are listed below:

RA 1 - Major Cities of Australia RA 2 - Inner Regional Australia RA 3 - Outer Regional Australia RA 4 - Remote Australia RA 5 - Very Remote Australia

Overall there was a 70% response rate to the general practitioner survey and a 75% response rate to the bi-annual general practice survey. These high response rates enable Rural Health West to offer contemporary valid data about trends in the rural general practice workforce to support workforce policy and planning.

The information in this report was current at the census date of 30 November 2012. The key findings are outlined in the Executive Summary and detailed in the body of the report.

1 http://www.doctorconnect.gov.au/internet/otd/Publishing.nsf/Content/locator


http://www.doctorconnect.gov.au/internet/otd/Publishing.nsf/Content/locator

2. Executive Summary

This section of the report sets out brief comparisons and trends for the general practice workforce in RA 2 to RA 5 in Western Australia at the most recent census date of 30 November 2012.

Number of general practitioners

As at 30 November 2012, the number of general practitioners (GPs) known to be practising in RA 2 to RA 5 locations was 741 (including GP registrars). This represents an increase of 6% compared to November 2011. The largest proportional increases in the workforce by GP type were Fly In/Fly Out (FIFO) doctors with an additional 20 (43.5%) and GP registrars with an additional 19 (28.4%) working in RA 2 to RA 5 locations.

Age and gender

The average age of the overall GP workforce was 48.4 years. This figure has increased by 4.1 years since 2001 and 0.5 years since 2011.

The majority of the workforce (58%) was aged between 35 and 54 years. However, doctors aged 55-64 years made up 23% of the workforce in 2012.

There continues to be more males in the workforce than females, although the number of females has been rising since 2005.

The female workforce increased by 10 compared to 2011; however the overall percentage of female doctors in 2012 (35.8%) was lower than for 2011 (36.5%).

Location

66.5% of GPs worked in RA 2 (Inner Regional) and RA 3 (Outer Regional) locations whilst RA 5 (Very Remote) contained the smallest proportion of the GP workforce with 8.5%.

GPs working in rural and remote Western Australia encompass three rural Medicare Locals and four metropolitan Medicare Locals. The South West WA Medicare Local contains almost half the GP workforce (43%).

The greatest increase in numbers of doctors between 2011 and 2012 was in the Kimberley-Pilbara Medicare Local (23 doctors) and the region experiencing the greatest loss was the Goldfields-Midwest Medicare Local (-13 doctors).

Working hours

The average self-reported clinical workload was 41.8 hours per week.

The average hours worked per week has decreased by 4.6 hours since 2006 and 0.3 hours since November 2011. Male doctors in all age groups continued to work longer clinical hours per week than their female counterparts.

There was a reduction of 2.8% in the self-reported full-time workforce compared to 2011 and more males worked full-time than females.

Doctors in the more remote areas of RA 4 (Remote) and RA 5 (Very Remote) worked greater average hours per week than their colleagues in less remote areas.


Turnover

Turnover of the workforce from 30 November 2011 to 30 November 2012 was 13.61%, a decrease of 2.25% from the period prior.

12 less doctors departed the workforce during this period than the previous period. The most common destination for doctors leaving rural and remote Western Australia was Perth (39.5%), interstate (14%) and overseas (9.3%).

17 additional doctors joined the permanent workforce during this period, compared to 8 in 2011 and 22 in 2010. The proportion of arrivals from overseas, interstate and Perth was fairly equal.

12 doctors joined the permanent workforce from GP training programs, representing 9.3% of all new arrivals.

The male GP workforce experienced a lower turnover rate (12.9%) and a higher arrivals rate (8.3%), increasing the overall male workforce numbers by 36.

The permanent female GP workforce increased by 7 doctors compared to 23 in 2011.

The GP workforce continued to gain doctors in the older age groups. There was a 22.5% increase (9 additional doctors) in the 65+ years age group in 2012.

Length of employment

The average length of employment in current practice was 7.2 years, which was 0.1 year higher than the two previous reporting periods.

Doctors employed for less than 1 year decreased 4% compared to 2011, while doctors employed between 1 to 5 years increased by 4% and doctors employed for more than 5 years remained the same.

The majority of long-stay doctors were in RA 2 and RA 3. RA 5 had the highest proportion of newly arrived doctors (29%) down from 39.1% in 2011.

Proceduralists

There were 202 proceduralists recorded as at 30 November 2012, an increase of 21 compared to the prior reporting period. The proportion of overall GPs who regularly practised in one or more procedural area remained static in this last reporting period.

The gender distribution of GPs practising in each procedural field remained disproportionate to that of the GP workforce. At 30 November 2012, 35.8% of the overall workforce was female, whilst only 23.3% of GP proceduralists were female.

There has been a 75% increase in the overall number of female proceduralists between 2006 and 2012; however, the only procedural area that has shown sustained growth is obstetrics, which increased by five in 2012.

Overseas trained GP proceduralists comprised 34.2% of the proceduralist workforce in 2012, compared to 35.4% in 2011 and 35.9% in 2010.

The average age of the GP proceduralist workforce decreased by 0.3 years between 2011 and 2012. Overall, the average age of the proceduralist workforce (48.0 years) was lower than the average age of the overall workforce (48.4 years).


International Medical Graduates

As at 30 November 2012, 51.8% of the rural and remote medical workforce in Western Australia had obtained their basic medical qualification overseas. This was 0.7% less than 2011 and is the lowest proportion since 2007.

During this current reporting period, there was an increase in both the number and percentage of Australian citizens (505 or 68.2%) and Permanent Residents (149 or 20.1%) in the GP workforce compared to 2011. Temporary Residents decreased from 105 (15%) to 87 (11.7%) compared to 2011.

33 doctors were registered on the Five Year Overseas Trained Doctors Scheme, 6 less than in 2011.

GP registrars

There were 86 GP registrars in the rural workforce in the current census period, 19 more than 2011 and the highest figure recorded. This growth reflected the presence of three training organisations for GP registrars now operating in Western Australia – Western Australian General Practice Education and Training Limited (WAGPET), Australian College of Rural and Remote Medicine (ACRRM) and Rural Vocational Training Scheme (RVTS).

The average age of GP registrars has increased from 32.0 years in 2002 to 36.5 years in 2012.

The proportion of the registrar population who trained overseas decreased by 2.1% since 2011 but at 44.2% of all GP registrars remains higher than any other year recorded.

Aboriginal Medical Service practices

The number of GPs in Aboriginal Medical Service (AMS) practices decreased by 1 in 2012 but overall has remained virtually the same percentage of the overall GP workforce since 2002 (7% to 8%).

The proportion of International Medical Graduates in AMS practices increased to 55.3% in the current reporting period, compared to 50.0% in 2011.

The 37.5% turnover rate in AMS practices between November 2011 and November 2012 was significantly higher than for 2011 (25.0%) and also consistently higher than for the overall GP workforce at 13.6% in 2012.

The proportion of female GPs working in AMS practices increased by 1.1% in 2012 and at 53.2% is the highest level recorded. AMS practices continued to have a consistently greater proportion of female GPs compared to the overall female workforce of 32.7% in 2012.


3. Data collection and analysis strategies

Since 2001, Rural Health West has maintained an up-to-date database of the rural and remote medical workforce in Western Australia in accordance with the national Minimum Data Set (MDS) requirements.2 Rural Health West collects and updates information about general practice workforce participation on an ongoing basis from sources including:

The annual GP workforce survey

Twice yearly general practice surveys

Medicare Locals

GP Networks

Western Australian General Practice Education and Training Limited

Australian Health Practitioner Regulation Agency registers

Personal contact with practices and GPs

Since July 2010, workforce data has been collected for RA 2 to RA 5 locations3.

WA Country Health Service (WACHS) District Medical Officers (DMOs) and Senior Medical Officers (SMOs) are included as, due to their locations, these doctors are considered to perform GP-type services in their communities. Salaried DMOs, SMOs and Regional Medical Officers (RMOs) at Bunbury Regional Hospital, Geraldton Regional Hospital, Kalgoorlie Regional Hospital and Peel Health Campus (Mandurah) have not been included as, due to the size of the hospitals and the number of GPs in those areas, these doctors are not considered to be performing primary GP services.

The full GP workforce survey was distributed in September 2012 to all doctors on the Rural Health West database identified as working in regional, rural and remote Western Australia. A reduced two-page survey covering only the national MDS questions was distributed in early November 2012 to those GPs who had not returned their original survey. Additionally, the survey was available online.

Overall there was a 70% response rate to the general practitioner survey. This high response rate enables Rural Health West to offer contemporary valid data about trends in the general practice workforce in RA 2 to RA 5 locations in Western Australia to support workforce policy and planning.

The 2012 MDS Report presents the data as at 30 November 2012, and where appropriate, makes comparisons with data from previous years.

A key change to the GP workforce analysis in this 2012 MDS Report is the application of Medicare Local boundaries, which have replaced GP Networks/Divisions of General Practice boundaries as a reporting criterion. The national network of 61 Medicare Locals are a key component of the National Health Reform agenda. GPs working in RA 2 to RA 5 in Western Australia encompass three rural Medicare Locals and four metropolitan Medicare Locals.

2 The national Minimum Data Set was developed by the State Rural Workforce Agencies in conjunction with the Australian Government to

describe the workforce participation of GPs living in non-metropolitan Australia.

3 http://www.doctorconnect.gov.au/intenet/otd/Publishing.nsf/content/RA-info


http://www.doctorconnect.gov.au/intenet/otd/Publishing.nsf/content/RA-info

4. Demographics of GP workforce as at 30 November 2012

This section describes the GP workforce by service model, age, gender and location.

As at 30 November 2012, there were 741 GPs known to be practising in RA 2 to RA 5 locations. This represents an increase of 6% compared to 30 November 2011.

Models of service provision

Table 1 indicates the number of GPs in each primary model of service provision, based upon the National Data Dictionary classifications.

Table 1 GP numbers by primary model of service provision 2011 v 2012

Primary Model of service provision 2011 2012 Difference

Resident GP 479 483 4 0.8%

FIFO* 46 66 20 43.5%

Member of a primary health care team** 48 47 -1 -2.1%

WA Country Health Service (DMO/SMO)*** 56 56 0 0.0%

GP registrar 67 86 19 28.4%

Other 3 3 0 0.0%

Total 699 741 42 6.0%

* Primarily Royal Flying Doctor Service, but now also includes FIFO WACHS DMOs and SMOs and private GPs. ** Primarily AMS practices. *** Salaried DMOs, SMOs and Regional Medical Officers (RMOs) at Bunbury Regional Hospital, Geraldton

Regional Hospital, Kalgoorlie Regional Hospital and Peel Health Campus (Mandurah) have not been included as, due to the size of the hospitals and the number of GPs in those areas, these doctors are not considered to be performing primary GP services.

FIFO GPs represented the largest proportional increase in the rural and remote GP workforce with an additional 20 (43.5%) working in RA 2 to RA 5 locations. Whilst most of these numbers are Royal Flying Doctor Service (RFDS) doctors, the remainder are FIFO private practitioners, WACHS or AMS GPs. The number of FIFO GPs coming from Perth and interstate has increased considerably in the past two years.

A significant increase in GP numbers was also recorded for GP registrars, representing increased rural placements from all three training providers. Of the 86 GP registrars recorded, 65 were with WAGPET, 12 were with the RVTS and 9 were with ACRRM.

These figures do not include short-term locums who may be temporarily covering vacancies in the permanent workforce.


GPs by age and gender

Average age of all GPs

The average age of all GPs at 30 November 2012 was 48.4 years. The average age for male GPs was 50.4 years and 45 years for females. Figure 1 compares the average age since 2001 and shows that the average age of the overall rural and remote workforce has increased by 4.1 years since 2001 and by 0.5 years since 2011.

The average age for male GPs increased 0.4 years from 50 years in 2011 to 50.4 years in 2012. The average age for female GPs increased 0.7 years from 44.3 years in 2011 to 45 years in 2012.

Figure 1 Average age of GP workforce 2001 to 2012


GPs by age group and gender

Figure 2 indicates that the majority of the workforce (58%) is aged between 35 and 54 years. This is lower than in 2011 when these age groups represented 63% of the overall workforce. There are more male GPs in each age group than females, apart from the younger group aged between 25 and 34 years, where there are more females, which is a similar pattern to 2010 and 2011.

Figure 2 Composition of the GP workforce by ten-year age group and gender as at 30 November 2012


Figure 3 compares GP numbers by gender for the years 2003 to 2012 and the percentage of the female workforce in each of those years.

Figure 3 Number of GPs by gender and percentage of female GPs 2003 to 2012

There were 10 more female GPs working in rural Western Australia in 2012 compared with 2011. While this meant that the actual proportion of female GPs in the overall workforce decreased 0.7% from 2011, their representation in the workforce in 2012 was still higher than for any previous year other than 2011.


GP numbers by location

GP numbers by Remoteness Area

Commencing in 2010, GP work locations have been recorded and analysed using the ASGC- RA system and data is now available for three census years. GPs employed by the RFDS based in Jandakot (RA 1 location), work across RA 2 to RA 5 locations.

Table 2 shows the number of GPs within each RA in 2012 compared to 2011.

Table 2 GP numbers by Remoteness Area

Remoteness Area 2011 2012 Actual

Difference % Difference

2 (Inner Regional) 249 276 27 35.6%

3 (Outer Regional) 225 217 -8 32.2%

4 (Remote) 149 159 10 21.3%

5 (Very Remote) 52 63 11 7.4%

1 (RFDS) 24 26 2 3.4%

Overall 699 741 42 100.0%

This table shows that the greatest increase in GP numbers in 2012 occurred in RA 2 with 27 additional doctors. Overall, the majority of GPs worked in RA 2 (inner regional) and RA 3 (outer regional) locations (493 GPs or 66.5%) in 2012. This compares to 474 GPs (67.8%) in 2011 and 465 GPs (69.3%) recorded in 2010.


GP numbers by Medicare Local

A key change to the GP workforce analysis in this 2012 MDS Report is the application of Medicare Local boundaries, which have replaced GP Networks/Divisions of General Practice boundaries as a reporting criterion. GPs working in RA 2 to RA 5 in Western Australia encompass 3 rural Medicare Locals and 4 metropolitan Medicare Locals.

The following table identifies and compares GP numbers within Medicare Local boundaries in 2011 and 2012.

Table 3 GP numbers by Medicare Local boundaries 2011 v 2012

Medicare Local 2011 2012 Actual Difference % Difference

South West WA 302 319 17 5.6%

Kimberley-Pilbara 131 154 23 17.6%

Goldfields-Midwest 141 128 -13 -9.2%

Perth South Coastal (Metro) 95 107 12 12.6%

Fremantle (Metro) 25 27 2 8.0%

Perth North Metro 2 3 1 50.0%

Perth Central & East Metro 3 3 0 0.0%

Total 699 741 42

The South West WA Medicare Local contains almost half of the GP workforce in RA 2 to RA 5 locations in Western Australia (43%). The greatest increase in numbers of doctors between 2011 and 2012 was in the Kimberley-Pilbara Medicare Local (23 doctors) and the region experiencing the greatest loss was the Goldfields-Midwest Medicare Local (13 doctors).


5. Changes in the permanent GP workforce

The following section describes turnover of the GP workforce. WAGPET GP registrars are not included in this section because, although they form a significant proportion of the workforce, the length of their terms of employment range from 6 to 12 months and as such, they are not part of the permanent workforce. Their numbers are included in the arrivals section if they have continued working in rural and remote Western Australia on completion of their traineeship.

In past years, GP registrars undergoing the ACRRM Independent Pathway or RVTS programs were also excluded from reporting on the permanent GP workforce. However, in 2012, these doctors have been re-instated as non-registrars, because they do form a part of the permanent workforce, unlike WAGPET registrars. The ACRRM and RVTS doctors must be in situ in a rural area before they can begin either program, and these doctors generally finish their three year training in the one place, and are thus relied upon as permanent staff.

Overall GP workforce turnover

Table 4 details the turnover rate of GPs between November 2011 and November 2012. This movement represents a 13.61% turnover during this period, a decrease of 2.25% from the previous period. The percentage increase in the workforce was 6.8% compared to a 2.27% increase in 2011.

Table 4 GP turnover November 2011 to November 2012 (excluding WAGPET GP registrars)

Number of permanent GPs November 2011 632

Number of departures 86

Turnover 13.61%

Number of arrivals 129

Number of permanent GPs November 2012 675

% Increase 6.8%


Table 5 shows the destinations of GPs who departed between November 2011 and November 2012 and compares this with the departure destinations for the previous period.

Table 5 Destinations of departing GPs 2011 v 2012

2011 2012

Destination Number % Number %

Perth 26 26.5% 34 39.5%

Extended Leave 12 12.2% 16 18.6%

Interstate 16 16.3% 12 14.0%

Overseas 12 12.2% 8 9.3%

Other 6 6.1% 7 8.1%

Retirement 5 5.1% 5 5.8%

Locum 3 3.1% 2 2.3%

Trainee 18 18.4% 2 2.3%

Total 98 100.0% 86 100.0%

There were 12 fewer departures in the 12 month period to November 2012 than for the preceding 12 months. The most common destination for all doctors leaving rural and remote Western Australia in 2012 was to Perth, with 34 departing (39.5% of total departures).

Table 6 shows the origins of GPs joining or rejoining the permanent workforce between November 2011 and November 2012.

Table 6 Origins of GPs joining the workforce 2011 v 2012

2011 2012

Origin Number % Number %

Overseas 29 25.9% 29 22.5%

Interstate 25 22.3% 30 23.3%

Perth 36 32.1% 29 22.5%

Extended Leave 12 10.7% 14 10.9%

Trainee Program 6 5.4% 12 9.3%

Roving Locum 3 2.7% 4 3.1%

Other 1 0.9% 11 8.5%

Retirement 0 0.0% 0 0.0%

Total 112 100.0% 129 100.0%


17 additional doctors joined the permanent workforce between November 2011 and November 2012, compared with 8 for the previous reporting period. The proportion of arrivals from overseas, interstate and Perth was similar. Some of the new doctors, particularly from Perth and interstate are FIFO doctors working at WACHS hospitals. The increase in ‘Other’ reflects the ACRRM Independent Pathway and RVTS doctors mentioned at the beginning of this section.

The percentage of overseas trained doctors joining the permanent workforce has decreased slightly, and 2012 marked the first year that arrivals directly from overseas were below 25%. However, many of the arrivals from Perth and interstate were actually overseas trained doctors. In 2012, 79% of arrivals from Perth were overseas trained, compared to 52.8% in 2011 and 37% in 2010.

12 doctors joined the permanent workforce from the GP training program in 2012 compared to six in 2011 and represented 9.3% of all new arrivals.

GP workforce changes by gender

Table 7 summarises the changes in the permanent GP workforce by gender between 30 November 2011 and 30 November 2012, excluding WAGPET GP registrars.

Table 7 Changes in GP workforce by gender 2011 to 2012 (excluding WAGPET GP registrars)

Gender Number of

GPs Nov 11 Departures % Departed Arrivals

Number of GPs Nov 12

% Increase

Male 418 54 12.9% 90 454 8.6%

Female 214 32 15.0% 39 221 3.3%

Total 632 86 13.6% 129 675 6.8%

The male GP workforce experienced a lower turnover rate than the female workforce (12.9%) and a higher arrivals rate (8.6%), increasing their overall workforce numbers by 36. However, as explained above, many of these new arrivals are FIFO doctors, or non-WAGPET registrars. The permanent female workforce grew by 7 doctors.


Figure 4 compares GP turnover figures by gender for the period 2004 to 2012.

Figure 4 GP turnover rates by gender 2004 to 2012 (excluding WAGPET GP registrars)

The overall turnover rate fell in 2012 compared to 2011 and the female turnover rate has returned to being higher than that of the male workforce, as in years prior to 2011.


GP workforce changes by Remoteness Area

Table 8 illustrates the changes in the GP workforce by RA. This table shows movements in and out of the rural and remote GP workforce, as well as movement within the state between varying RA locations.

Table 8 Changes in GP workforce by Remoteness Area 2011 v 2012 (excluding WAGPET GP registrars)

Movements OUT of rural

Western Australia

Movements INTO rural

Western Australia

RA

No. per RA Nov 2011

Left rural WA

Moved to

another rural RA

Total Out

% of RA departed

Arrived from

outside rural WA

Arrived from

another rural RA

Total In

No. per RA Nov 2012

2 232 23 0 23 9.9% 39 2 41 250

3 203 28 2 30 14.8% 25 2 27 200

4 127 24 6 30 23.6% 39 2 41 138

5 46 7 0 7 15.2% 19 4 23 62

Metro (RFDS)

24 4 2 6 25.0% 7 0 7 25

Overall 632 86 10 96 129 10 139 675

Between November 2011 and November 2012, 86 doctors left rural Western Australia and a further 10 doctors moved from one rural RA to another RA location, totalling 96 doctor departures from all RAs. Over the same period, a total of 139 GPs moved into RA 2 to RA 5 locations, including 129 from outside rural Western Australia and the 10 who moved from one RA location to another.

Excluding RFDS Jandakot doctor movements, locations in RA 4 experienced the greatest proportional movements out (23.6% of all departures) but experienced a net gain over the period. RA 5 experienced the least movement inward, with only 23 new doctors and the second highest turnover rate (15.25%). As in 2011, RA 2 was the most stable with the lowest turnover rate (9.9%) and equal highest number of new arrivals (41).


Table 9 outlines the destinations of GPs who departed rural Western Australia in 2012 by RA. Overall the majority of all departures (39.5%) were to Perth. The number of departures from RA 3 was higher than from other locations and accounted for 33% of all departures, with the majority of those departures being to Perth (65%).

Table 9 Destinations of GPs who departed rural Western Australia in 2012 by Remoteness Area

Destination RA 2 RA 3 RA 4 RA 5 Metro (RFDS) Total

Perth 9 14 6 2 3 34

Leave 7 5 3 0 1 16

Interstate 1 3 6 2 0 12

Overseas 1 3 3 1 0 8

Other 0 1 4 2 0 7

Retirement 3 2 0 0 0 5

Locum 1 0 1 0 0 2

Trainee 1 0 1 0 0 2

Total 23 28 24 7 4 86


GP workforce changes by age group

Table 10 summarises the changes in workforce numbers by age group for the current reporting period.

Table 10 Changes in GP numbers by age group 2011 to 2012 (excluding WAGPET GP registrars)

Age group

No. in age

group Nov 2011

Departed rural WA

% of age group

departed

Arrivals into rural WA

Moved to next

age group

Moved from

previous age

group

No. in age

group Nov 2012

% Increase

in age group

25-34 40 11 27.5% 25 4 0 50 25.0%

35-44 198 30 15.2% 38 17 4 193 -2.5%

45-54 207 30 14.5% 32 14 17 212 2.4%

55-64 147 10 6.8% 27 7 14 171 16.3%

65+ 40 5 12.5% 7 0 7 49 22.5%

Total 632 86 13.6% 129 42 42 675 6.8%

The youngest age group (25 to 34 years) had both the highest arrival rate (25%) and departure rate (27.5%), and a net gain of 10 doctors. This reflects the greater mobility of this age group. This age group also experienced greatest departure rates in 2010 and 2011.

The second highest increase was in the 65+ year group (22.5%). This table indicates that overall, rural and remote Western Australia continues to gain doctors in the older age groups and loses those in the younger age groups.


6. Clinical workloads

Estimates of Full Time Equivalents (FTEs) and Full Time Workload Equivalents (FWEs) as used by Medicare Australia in calculating GP medical service provision are based solely on the number and dollar value of claims made by a provider over a given reference period (usually 12 months).

While this is a useful measure of overall service provision under Medicare, it does not reflect the number of hours worked by rural and remote GPs in providing medical services that are not claimed or are not claimable through Medicare Australia. Specific services not included are after-hours work in the hospital setting and obstetric and anaesthetic services provided to public patients by GPs. These services can represent up to 40% of procedural GPs’ workloads and thus are significant in the underestimation of actual workload.

An alternative measure of service provision is the number of clinical hours worked. For the purposes of this report, clinical hours worked include:

Hours worked in GP practice.

Hours worked in hospital.

Hours worked on call-outs ( not hours available on-call).

Hours worked in population health.

Hours travelled between principle practice and other places of primary care provision.

Hours reported cannot be interpreted as total hours worked because non-clinical tasks such as teaching, administration and supervision are not included.

It is important to note that unlike previous sections of this report where data was available for 100% of GPs (via the GP and practice surveys and other contacts), this section only includes data taken from the GP survey. Thus, there are no hours recorded for GPs who did not return their surveys. GPs working for the RFDS have also not been included in this analysis because exact clinical hours and on-call hours are difficult to distinguish due to the nature of their service. This section therefore covers 484 doctors, including GP registrars, or 65.3% of the workforce for this reporting period.


Average hours worked per week

At November 2012 the average self-reported clinical workload was 41.8 hours per week, compared to 42.1 hours per week in November 2011.

Figure 5 displays the average hours worked each year from 2006 to 2012. This shows that the average number of hours worked per week continues to decline and has decreased by 4.6 hours since 2006.

Figure 5 Average hours worked per week from 2006 to 2012


Average hours by gender and age group

Figure 6 provides a breakdown of average weekly clinical hours worked by gender and age group and shows that male doctors in all age groups continued to report working longer clinical hours per week than their female counterparts. This likely reflects the fact that a greater proportion of the female workforce reported working part-time (see Table 11).

Figure 6 Average hours worked per week by gender and ten-year age groups


Full-time and part-time workloads

The Australian Bureau of Statistics (ABS) defines full-time work as being 35 hours per week or more and part-time work as less than 35 hours per week. It is this measure that has been chosen by Rural Health West and other Rural Workforce Agencies to differentiate between full-time and part-time service provision. Using this benchmark, Table 11 provides a comparison between part-time and full-time workloads by gender.

Table 11 Comparison between part-time and full-time workloads by gender

Type of workload Male Female Total % of respondents

Full-time 257 94 351 72.5%

Part-time 53 80 133 27.5%

Total respondents 310 174 484 100.0%

351 doctors (72.5% of respondents) self-reported working full-time in the provision of routine clinical GP services. This represents a reduction of 2.8% in the self-reported full-time workforce compared to 2011. Of these full-time doctors in 2012, the vast majority were male (257 male, 94 female). This is a similar pattern to 2011 (267 male, 99 female) and 2010 (277 male, 93 female) where there were significantly more males working full-time than females.

Conversely, 133 doctors (27.5% of respondents) self-reported as working part-time. Of these part-time doctors, there were more females than males (80 female, 53 male). The overall proportion of GPs working part-time is increasing (27.5% in 2012, 24.7% in 2011 and 19.7% in 2010).

Table 12 looks specifically at this part-time workforce, comparing by gender those who self-reported as working part-time in the current reporting period.

Table 12 Part-time workforce by gender 2011 v 2012

Yea

r

To

tal

mal

es

Mal

esw

ork

ing

par

t ti

me

% o

f to

tal

mal

es

To

tal f

emal

es

Fem

ales

wo

rkin

gp

art

tim

e

% o

f to

tal

fem

ales

To

tal

resp

on

den

ts

% o

f to

tal

resp

on

den

tsw

ork

ing

par

t ti

me

2011 302 35 11.6% 184 85 46.2% 486 24.7%

2012 310 53 17.1% 174 80 46.0% 484 27.5%


Average hours worked per week by Remoteness Area

Figure 7 identifies the average hours worked per week by RA location and shows an inverse relationship between hours worked and remoteness; ie GPs working in more remote locations work more hours per week on average compared with their colleagues in less remote areas.

Figure 7 Average hours per week by Remoteness Area

Compared to 2011, the average hours worked per week by RA location increased in RA 3 (from 42.0 hours in 2011 compared to 42.4 hours in 2012) and RA 5 (from 45.7 hours in 2011 compared to 48.8 hours in 2012).

The average hours worked per week reduced in RA 2 (from 40.3 hours in 2011 compared to 39.1 hours in 2012) and RA 4 (from 44.5 hours in 2011 compared to 43.8 hours in 2012).


7. Length of employment in current principal practice

Average length of employment

Across rural and remote Western Australia, the average length of employment in current principal practice for all GPs (not including GP registrars) was 7.2 years, 0.1 year higher than the previous two periods. These figures are calculated on time worked in the doctor’s current practice and do not include time spent in other rural or remote practices.

Figure 8 shows the proportion of the GP workforce who have been in their current positions in each ‘length of employment’ category.

Figure 8 Length of employment in current principal practice (excluding WAGPET GP registrars)

Data collected in 2012 shows variations in length of current employment. Doctors employed for less than 1 year (< 1 year) has decreased 4% from that in 2011, while doctors employed for between 1 and 5 years (1 - 5 years) has increased by 4% and doctors employed for more than 5 years (>5 years) has remained the same.


Average length of employment by Remoteness Area

Figure 9 compares the length of employment in current principal practice for GPs across RA categories. Again, figures for GP registrars are excluded from this discussion. This chart shows that the majority of long-stay doctors are in RA 2 and RA 3. By contrast, in RA 5 there are only 16.1% long-term doctors, down from 19.6% in 2011 and 23.3% in 2010. RA 5 again has the highest proportion of newly arrived doctors (29%), down from 39.1% in 2011.

Figure 9 Length of employment in current principal practice by Remoteness Area


8. Practice type

Table 13 shows the number of doctors in each RA who were solo practitioners, compared with the number working in group practices. There were seven less GPs (49) working in solo practices in 2012 compared to 2011 (56) and the proportion of the solo GP workforce was also lower in 2012 (6.6%), compared to 8% in 2011. The solo practitioner component of the workforce varied widely across geographical locations, with the highest proportion (12.7%) being in RA 5 locations, followed by RA 4 locations (9.4%).

Table 13 Number of GPs by practice type by Remoteness Area

Remoteness Area Group Solo % Solo

2 (Inner Regional) 264 12 4.3%

3 (Outer Regional) 203 14 6.5%

4 (Remote) 144 15 9.4%

5 (Very Remote) 55 8 12.7%

1 (RFDS) 26 0 0.0%

Overall 692 49 6.6%

Table 14 delineates the number of practices in each RA (excluding WACHS hospitals). The reported number of practices in 2012 was 184, down from 187 in 2011, with the major differential being the decrease in reported solo practices from 56 in 2011 to 46 in 2012.

The discrepancy between the total number of solo practitioners (49) and the total number of solo practices (46) is caused by 4 FIFO doctors servicing Pannawonica. These GPs job share, and thus there is only ever 1 GP there at a time.

Table 14 also shows that the majority are group practices in RA 2 and RA 3, which follows the trend of previous reporting periods.

Table 14 Number of practices per Remoteness Area (excluding WACHS hospitals)

Remoteness Area

Group practice

Solo practice

Aboriginal Medical Service

Solo GP co-located

Number of practices

2 53 12 2 0 67

3 44 14 2 1 61

4 15 15 5 1 36

5 6 5 7 0 18

1 (RFDS) 2 0 0 0 2

Total 120 46 16 2 184


9. GP proceduralists

Number of GP proceduralists

In the annual census, GPs are asked whether they practised in the following clinical areas:

Anaesthetics - regional and general

Obstetrics − normal deliveries, Lower Segment Caesarean Section and non-Lower Segment Caesarean Section

General surgery

Figures for general anaesthetics, obstetrics (excluding shared care) and general surgery are analysed for this report. The number of GPs regularly practising each of these procedures is displayed in Table 15 along with the percentage of the total workforce these GPs represented in 2012.

Table 15 Numbers and proportions of GPs practising procedures 2011 v 2012

Procedure n 2011 % of total GPs 2011 n 2012 % of total GPs 2012

Anaesthetics 95 14% 108 15%

Obstetrics 115 16% 121 16%

Surgery 29 4% 33 4%

There were 202 GP proceduralists as at November 2012 (21 more than 2011), many of whom practised in more than one procedural area. A Venn diagram illustrating practitioners practising in single or multiple procedural areas is displayed at Figure 10.

The percentage of overseas trained GP proceduralists has increased from 8.8% in 2001 to 34.2% in 2012.

Figure 10 Numbers of GPs undertaking procedural work

Of the 202 proceduralists:

6 practised all three procedures 48 practised two procedures 148 practised one procedure

There are 539 GPs who do not regularly practice in any procedural area.

A = Anaesthetics O = Obstetrics S = Surgery


Figure 11 illustrates the fluctuations in overall GP proceduralist numbers and proportions between 2005 and 2012. This picture shows the first increase in proceduralist numbers since 2008 and a subsequent increase in the proportion of the overall workforce who regularly practise in one or more procedural area.

Figure 11 Number and proportions of GP proceduralists 2005 to 2012


GP proceduralists by gender

Figure 12 provides the numbers and proportions of GP proceduralists by gender and shows that female GPs practising in each procedural field remains disproportionate to their representation in the overall Western Australian rural and remote GP workforce.

35.8% of the overall workforce was female in 2012 (see Figure 3), whilst only 23.3% of the GP proceduralist population was female (13.9% of GP anaesthetists, 27.3% of GP obstetricians and 12.1% of GPs practising general surgery). This represents an increase from a proportion of 21.6% female proceduralists in 2011 and is comparable to the 23.5% proportion of female proceduralists in 2010.

Figure 12 Number of GP proceduralists by gender 2012


Figure 13 compares the number of female GP proceduralists between 2006 and 2012. This graph shows that there has been an overall increase of 75% in the number of female GP proceduralists over the last six years. However, the only procedural area that has shown a sustained growth is obstetrics.

Figure 13 Number of female GP proceduralists between 2006 and 2012


GP proceduralists by age

Figure 14 shows the average age of proceduralists between 2006 and 2012.

Figure 14 Average age of GP proceduralists 2006 to 2012

There was a decrease of 0.3 years in the average age of the GP proceduralist workforce between 2011 and 2012. The average age of the proceduralist workforce has only increased by 0.7 years since 2006, compared with the overall workforce, which has aged 1.5 years in the same period.

Bringing younger doctors into the procedural workforce underpins the GP Obstetrics Mentoring Program. Rural Health West is funded to provide this mentoring and support program to GP registrars in Western Australia who have recently completed the Basic or Advanced Diploma of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).

The GP Obstetrics Mentoring Program is a collaborative venture between key stakeholder organisations committed to maintaining robust GP procedural obstetric services in rural Western Australia.

2007 saw the establishment of a pilot program to support and mentor recent RANZCOG Diplomates to enable them to gain the skills and experience required to work independently as rural GP obstetricians. The program demonstrated that having a mentor available to assist with deliveries and discuss obstetric cases on a regular basis improved the confidence of the Diplomate.

Since the successful pilot in 2007, the program has grown to support 7 rural and 2 outer metropolitan Diplomates each year. GP registrars (mentees) are matched with experienced GP obstetricians or specialists (mentors) for a twelve month term, with scholarship funding provided to both. To date, 33 rural GP registrars have successfully completed the program.


10. Country of training and residency

Country of training

Figure 15 displays the number of GPs who trained in Australia compared with overseas, and the percentages of the total workforce who were International Medical Graduates, from 2005 to 2012.

Figure 15 Number and percentage of International Medical Graduates 2005 to 2012

At 30 November 2012, 51.8% of the rural and remote medical workforce in Western Australia had obtained their basic medical qualification overseas. This was 0.7% less than 2011, and is the lowest proportion since 2007.

Many of these International Medical Graduates are Australian Citizens or Permanent Residents and have practised medicine in Australia for many years and contribute significantly to the health of rural communities.


Figure 16 provides a breakdown of the countries in which the International Medical Graduates trained. The largest proportion of International Medical Graduates gained their basic medical qualification from the United Kingdom (23.7%), followed by South Africa (21.1%) and India (11.7%). These figures and patterns are consistent with the previous three periods.

Figure 16 Country of basic medical qualification (non Australian trained doctors)


In Table 6, it was noted that 29 new doctors arrived in rural Western Australia from overseas during the period November 2011 to November 2012. These doctors completed their basic medical qualifications in 11 different countries; however, the majority came from the United Kingdom (13 or 44.8%).

Residency

The residency status of the GP workforce as at 30 November 2012 is displayed in Table 16.

Table 16 Residency status of GP workforce 30 November 2012

Residency Number %

Australian Citizen 505 68.2%

Permanent Resident 149 20.1%

Temporary Resident 87 11.7%

Total 741 100.0%

As at 30 November 2012, 68.2% of the workforce was Australian citizens, an increase from 66% in 2011, 63.8% in 2010 and 63.7% in 2009.

There were 34 doctors practising under the Five Year Overseas Trained Doctors Scheme on 30 November 2012, 5 less than the previous period. This scheme provides opportunities for overseas trained doctors to obtain permanent residency after achieving Fellowship of The Royal Australian College of General Practitioners (FRACGP) or equivalent. These doctors must work in an Area of Need for five years (less in some remote areas) in order to obtain an unrestricted Medicare Provider Number.

Table 17 indicates the residency status of the scheme doctors.

Table 17 Residency status of doctors on the Five Year Overseas Trained Doctors Scheme 2011 v 2012

Residency 2011 % 2012 %

Australian Citizen 6 15.0% 4 14.7%

Permanent Resident 17 42.5% 14 41.2%

Temporary Resident 16 42.5% 15 44.1%

Total 39 100.0% 33 100.0%

There were 9 new doctors who joined the scheme during this period, 4 more than the period prior. Conversely, there were 15 doctors who left the scheme. Of those who left, 8 completed the scheme (all remaining in rural Western Australia); 2 moved to Perth, 2 moved to an ineligible location, 2 went on extended leave and 1 moved interstate.


11. GP registrars

The following section analyses the GP registrar workforce in rural and remote Western Australia. Figure 17 compares GP registrar numbers over the period 2002 to 2012.

Figure 17 Total number of GP registrars 2002 to 2012

The total number of GP registrars in the rural and remote Western Australian workforce in 2012 was 86, 19 more than 2011 and the highest figure recorded. This increase reflects the presence of three training organisations for GP registrars operating in Western Australia.

In 2012, the numbers in each program were WAGPET (66, an increase of 12 since 2011), ACRRM Independent Pathway (8, an increase of 1) and RVTS (12, an increase of 6).


The average age of GP registrars remains well below that of the non-registrar GP workforce as shown in Figure 18.

Figure 18 Average age of GP registrars 2002 to 2012


Figure 19 provides a comparative breakdown of GP registrar figures from 2003 to 2012, according to where they received their primary medical qualification. This shows that the number of GP registrars who completed their primary medical qualification overseas increased by 7 doctors in 2012, while the number of Australian trained registrars increased by 12. This is the highest number of Australian trained registrars in rural and remote Western Australia since 2003.

Figure 19 Number and proportion of overseas trained GP registrars 2003 to 2012

The proportion of the registrar population who trained overseas has decreased by 2.1% since 2011 (46.3%), but at 44.2% remains higher than any other year recorded. This increase can be attributed to the fact that the majority of ACRRM and RVTS registrars are overseas trained.


12. Aboriginal Medical Service practices

The following section analyses the GP workforce in rural and remote AMS practices. GP registrars are excluded from this analysis, as are the average of 9 private practice GPs per year who work at an AMS practice as a secondary practice.

Figure 20 charts the number of GPs who identified an AMS practice as their primary practice from 2002 to 2012 and shows a decrease of 1 doctor in 2012. Overall the percentage of the GP workforce identifying an AMS practice as their primary practice has not grown between 2002 and 2012.

Figure 20 Number of GPs in Aboriginal Medical Service practices v overall 2002 to 2012


Figure 21 identifies the average age of GPs in AMS practices from 2002 to 2012 compared to the overall age of the GP workforce in rural and remote Western Australia. In 2012, the average age of AMS practice GPs is higher than that of the overall workforce for the third consecutive year.

Figure 21 Average age of GPs in Aboriginal Medical Service practices v overall 2002 to 2012


Figure 22 charts the percentage of International Medical Graduates in AMS practices compared with the overall GP workforce between 2002 and 2012 and shows that the percentage of International Medical Graduates working in AMS practices as their primary practice has increased 5.3% since 2011.

Figure 22 Percentage of International Medical Graduates in Aboriginal Medical Service practices v overall 2002 to 2012


Figure 23 compares the turnover in AMS practices with the overall GP rate between 2003 and 2012 and shows a much higher turnover rate in AMS practices.

Figure 23 Comparison between turnover in Aboriginal Medical Service practices v overall 2003 to 2012


Figure 24 charts the percentage of female GPs in AMS practices compared with the overall workforce from 2002 to 2012.

Figure 24 Percentage of female GPs in Aboriginal Medical Service practices v overall 2002 to 2012

In 2012, the proportion of female GPs working in AMS practices increased by 1.1%. In 2012, AMS practices continued to have a consistently greater proportion of female GPs than the overall workforce with a variance of 20.5%.


minimum data set report and workforce - rural health west

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