Australian Medical Workforce Advisory Committee THE SPECIALIST OBSTETRICS AND GYNAECOLOGY WORKFORCES IN AUSTRALIA AN UPDATE: 2003 TO 2013 AMWAC Report 2004.2 April 2004 AMWAC 2004.2 © Australian Medical Workforce Advisory Committee 2004 ISBN 7347 36800 This work is copyright It may be reproduced in whole or part for study or training purposes subject to the inclusion of an acknowledgement of the source Reproduction for purposes other than those indicated above requires the written permission of the Australian Medical Workforce Advisory Committee Enquiries concerning this report and its reproduction should be directed to: Australian Medical Workforce Advisory Committee Level 73 Miller Street NSW Health Department NORTH SYDNEY NSW 2060 Telephone: E-mail: Internet: (02) 9391 9933 healthworkforce@doh.health.nsw.gov.au www.healthworkforce.health.nsw.gov.au Suggested citation: Australian Medical Workforce Advisory Committee (2004), The Specialist Obstetrics and Gynaecology Workforce – An Update 2003-2013, AMWAC Report 2004.2, Sydney Publication and design by Australian Medical Workforce Advisory Committee Printing by Artegra Imaging ii AMWAC 2004.2 CONTENTS Abbreviations v List of Tables vii List of Figures xi Terms of Reference of AMWAC and the AMWAC Obstetrics and Gynaecology Workforce Working Party xii Membership of AMWAC xiv Membership of the AMWAC Obstetrics and Gynaecology Workforce Working Party xvi Executive Summary 1 Introduction Health Workforce Planning – Definitions and Concepts Obstetrics and Gynaecology Workforce Data Sources 15 Provision of Obstetric and Gynaecological Services 18 Description of The Current Obstetrics and Gynaecology Workforce 25 Education and Training of the Obstetrics and Gynaecology Workforce 47 Adequacy of the Current Obstetrics and Gynaecology Workforce 55 Obstetrics and Gynaecology Workforce Supply Projections 68 Obstetrics and Gynaecology Workforce Requirement Projections 71 10 Balancing The Obstetrics and Gynaecology Workforce Supply And Requirement Projections 85 Recommendations 88 11 Appendices 90 References 132 iii AMWAC 2004.2 LIST OF APPENDICES Appendix A: Obstetric and Gynaecology Sub-Specialists Appendix B: RANZCOG Survey - Hours Worked Appendix C: General Practitioners Providing Obstetrics and Gynaecology Services Training Arrangements Appendix D: Medicare Data - Obstetrics and Gynaecology Appendix E: Projection of Birth Numbers - High and Low Fertility Assumptions Appendix F: Summary of Rural Remote and Metropolitan Areas Classification Appendix G: Trainee Obstetric and Gynaecology Specialist Data Appendix H: Funding of Different Models of Care According to Private Health Insurance Status of Woman Appendix I: Australian Rural and Remote Workforce Agencies - Rural and Remote General Practitioners Providing Obstetrics Services Appendix J: RANZCOG - Obstetrics and Gynaecology Workforce Survey 2003 Appendix K: Midwives Data Collection Forms Appendix L: Obstetrics and Gynaecology Workforce Projections - State and Territory 90 92 93 95 96 97 99 100 102 103 111 121 iv AMWAC 2004.2 ABBREVIATIONS ABS Australian Bureau of Statistics ACT Australian Capital Territory ACRRM Australian College of Rural and Remote Medicine AHMAC Australian Health Ministers' Advisory Council AHWOC Australian Health Workforce Officials’ Committee AIHW Australian Institute of Health and Welfare AMWAC Australian Medical Workforce Advisory Committee AoN Area of Need AR-DRG Australian Refined – Diagnosis Related Groups ARRWAG Australian Rural and Remote Workforce Agencies Group Aust Australia CSCT Certificate of Satisfactory Completion of Training in Women’s Reproductive Health DRANZCOG Diploma of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists FTE Full time equivalent GP General Practitioner HIC Health Insurance Commission IVF In-vitro fertilisation ITP Integrated Training Program JCCO Joint Consultative Committee on Obstetrics LUSCS Lower uterine segment caesarean section MTRP Medical Training Review Panel NPSU National Perinatal Statistics Unit v AMWAC 2004.2 NSW New South Wales NT Northern Territory OECD Organisation for Economic Co-operation and Development OTD Overseas Trained Doctor O&G Obstetrics and Gynaecology Pop Population Qld Queensland RACGP Royal Australian College of General Practitioners RACOG Royal Australian College of Obstetricians and Gynaecologists RANZCOG Royal Australian and New Zealand College of Obstetricians and Gynaecologists RRMA Rural, Remote and Metropolitan Areas classification SA South Australia Spec Specialist SPR Specialist to Population ratio Tas Tasmania Terr Territory TFR Total fertility rate TRD Temporary Resident Doctor Vic Victoria VMO Visiting Medical Officer WA Western Australia WHO World Health Organisation vi AMWAC 2004.2 LIST OF TABLES Table 1: Medicare providers: obstetricians and gynaecologists (excl IVF), 1996-97 to 2002-03 26 Table 2: AIHW medical labour force survey obstetrics and gynaecology specialists, 1995 to 2001 26 Table 3: Obstetrics and gynaecology sub-specialists, 1997 and 2003 28 Table 4: Obstetrics and gynaecology specialists/sub-specialists to population, by State/Territory, various data sources, 2003 29 Table 5: Obstetrics and gynaecology specialists/sub-specialists to population, by State/Territory, various data sources, 1998 30 Table 6: Distribution of the obstetric and gynaecology workforce, by State/Territory and geographic location, 2003 31 Table 7: Distribution of the obstetrics and gynaecology workforce, by State/Territory and geographic location (RACOG data), 1998 32 Table 8: Change in females as a proportion of the specialist workforce, by age group, 1997 and 2003 32 Table 9: Obstetric and gynaecology workforce (%), by age group, 1997 and 2003 34 Table 10: Average age of obstetrics and gynaecology specialists, by State and Territory, 2003 35 Table 11: Age profile of the obstetrics and gynaecology specialist workforce, by State/Territory and sex, 2003 36 Table 12: Obstetrics and gynaecology specialists, age, sex and average hours worked, 2001 37 Table 13: Obstetrics and gynaecology specialists, age, sex and average hours worked, 1995 37 Table 14: Obstetricians and gynaecologists, average hours worked per week, 1995 to 2001 39 Table 15: Obstetrics and gynaecology specialists, annual labour supply, by State/Territory, 1995, 1999 and 2001 40 Table 16: Specialists and sub-specialists in obstetrics and gynaecology average hours worked per week and annual labour supply hours, by State/Territory, 2003 41 Table 17: Specialist obstetricians and gynaecologists, hours worked, percent on call, age and distribution of the workforce, by geographic location, 1997 and 2003 42 Table 18: Obstetricians and Gynaecologists, intention to reduce hours in the three years from 2003 43 Table 19: Most common combinations of practice, obstetrics and gynaecology 44 Table 20: Obstetrics and gynaecology practice type (%), by sex, 2003 44 Table 21: Obstetrics and gynaecology practice type (%), by State, 2003 45 Table 22: Obstetrics and gynaecology practice type (%), by age group, 2003 45 Table 23: Obstetrics and gynaecology, summary of requirements for training and entry time, part time training, interrupted training and examinations, 2004 48 Table 24: Obstetrics and gynaecology vocational trainees, by State/Territory, 2003 49 Table 25: Obstetrics and gynaecology vocational training positions/trainees, by year of training, 2003 49 Table 26: Obstetrics and gynaecology vocational training positions/trainees in programs, 1994-2004 49 vii AMWAC 2004.2 Table 27: Obstetrics and gynaecology estimated first year training positions/trainees likely to be available in the next year, by year, 1997-2003 50 Table 28: AMWAC medical workforce reviews, recommended first year advanced trainee placements and number of first year advanced trainees in 2004 50 Table 29: Female obstetric and gynaecology vocational trainees (% of State/Territory trainees), by State/Territory, 2003 50 Table 30: Female obstetrics and gynaecology trainees (% of State/Territory total), by year, 1997-2003 51 Table 31: Rural/remote obstetric and gynaecology vocational training positions/trainees in programs, 2001 to 2004 51 Table 32: Doctors in vocational training - main location of training experiences (capital city, other urban, rural, and other), 2002 51 Table 33: Doctors in obstetric and gynaecology vocational training, by age, 2002 51 Table 34: Doctors in vocational training, stage of career when chose current discipline/vocational training program, 2002 52 Table 35: Doctors in vocational training, by marital status training program, 2002 52 Table 36: Doctors in vocational training, dependent children status, 2002 52 Table 37: Doctors in vocational training, by medical college training program, percent female, percent with dependent children, and percent in part-time or job-share training, 2002 52 Table 38: Doctors in vocational training - hours worked by doctors in full-time training, on average, per week during the past month, by medical college training program and sex, 2002 53 Table 39: Doctors in vocational training - satisfaction with the number of hours worked, by training program, 2002 53 Table 40: Doctors in vocational training - satisfaction with choice of discipline (%), by medical college training program, 2002 53 Table 41: Doctors in vocational training - ‘In 5-10 years’ time, you plan to practise full time or part-time?’, 2002 53 Table 42: New RANZCOG fellows, by State/Territory, 2003 54 Table 43: RANZCOG female new fellows (% of State/Territory fellows), by State/Territory, 2003 54 Table 44: New RANZCOG fellows, 2000-2003 54 Table 45: RANZCOG female new fellows (%), 2000 to 2003 54 Table 46: Waiting list statistics for patients admitted from waiting lists, by specialty of surgeon, State/Territory, 1999-00, 2000-01 and 2001-02 59 Table 47: Waiting list statistics for patients admitted from waiting lists, by indicator procedure, State/Territory, 1999-00, 2000-01 and 2001-02 60 Table 48: Average waiting time for new gynaecology patients, by insurance status 2003 61 Table 49: Average waiting time for new gynaecology patients by insurance status and geographical region, 2003 61 Table 50: Average waiting time in days for new gynaecology patients by insurance status and State/Territory, 2003 62 Table 51: Average waiting time in days for new obstetric and gynaecology patients, by insurance status and geographical region, 2003 64 Table 52: Employed obstetricians and gynaecologists (main occupation), proportion working above 65 hours per week, 1995 to 2001 64 viii AMWAC 2004.2 Table 53: Australian female population, 1998 report projections compared with actual and revised projections 72 Table 54: Australian female population estimates and projections, 2001 to 2021 72 Table 55: Percentage growth in Australian female population, 2006 to 2021 72 Table 56: Total fertility rate, by State/Territory, 1976 to 2001 74 Table 57: Births, birth rate and fertility rates 1986 to 1996 75 Table 58: Births, birth rate and fertility rates 1997 to 2001 75 Table 59: Total births, by State/ Territory, 1996 75 Table 60: Total births, by State/ Territory, 2001 76 Table 61: Caesarean sections and normal deliveries, with and without complicating diagnoses, 1997-98 to 2001-02 77 Table 62: Incidence of gynaecological cancers, 1994 and 1999 79 Table 63: Age-specific incidence rates of cervical cancer, Australia, 1999 79 Table 64: Age-standardised cervical cancer incidence rates, women aged 20 to 69 years, by State/Territory, 1995 to 1999 80 Table 65: Hospital obstetric and gynaecology separations, 1997-98 to 2001-02 81 Table 66: Obstetric and gynaecology hospital separations, actual and projected, 2001 to 2021 82 Table 67: Estimated annual growth in obstetrics and gynaecology requirements, by State and Territory 84 Table 68: Projected workforce shortage/oversupply in 2014, by State/Territory 87 Table 69: Obstetrics and gynaecology previous trainee intakes (199-2004) and recommended annual trainee intake, by State/Territory, 2005 onwards 88 Table A1: Qualified obstetric and gynaecology sub-specialist, 2004 90 Table A2: Qualified obstetric and gynaecology sub-specialists, by State/Territory, 2004 90 Table A3: Qualified obstetric and gynaecology sub-specialists, by geographic region, 2004 90 Table A4: Trainee obstetric and gynaecology sub-specialists, 2004 90 Table A5: Trainee obstetric and gynaecology sub-specialists, by year of training, 2004 90 Table A6: Trainee obstetric and gynaecology sub-specialists, by State/Territory, 2004 91 Table A7: Trainee obstetric and gynaecology sub-specialists, by geographic region, 2004 91 Table B1: Average total hours per week and annual hours worked, by gender and age group, 2003 92 Table C1: General practitioners with RANZCOG qualifications or traineeships, 2003 94 Table D1: Medicare providers: obstetrics and gynaecology (excl IVF) Australia, 1993-94 to 2001-03 95 Table D2: Medicare full time provider income thresholds, 1993-94 to 2002-03 95 Table E1: Projection of birth numbers to 2012, low fertility assumption Table E2: Projection of birth numbers to 2012, high fertility assumption 96 96 ix AMWAC 2004.2 Table G1: RANZCOG trainee obstetric and gynaecology specialist, by year of training, 2003 99 Table G2: RANZCOG first year trainee obstetrician and gynaecologists, by State/Territory, 1998-2004 99 Table H1: Summary of funding arrangements where woman elects to use private health insurance 100 Table H2: Summary of funding arrangements where woman either does not have or does not elect to use private health insurance 101 Table I1: Number and proportion of rural and remote GP obstetric proceduralists, by State/Territory 102 Table I2: Number and proportion of rural and remote GP obstetric proceduralists, by RRMA 102 Table L1: New South Wales + Australian Capital Territory obstetrics and gynaecology workforce projections Table L2: Victoria obstetrics and gynaecology workforce projections Table L3: Queensland obstetrics and gynaecology workforce projections Table L4: South Australia + Northern Territory obstetrics and gynaecology workforce projections Table L5: Western Australia obstetrics and gynaecology workforce projections 122 124 126 128 130 x AMWAC 2004.2 ... Table 23: Obstetrics and gynaecology, summary of requirements for training and entry time, part time training, interrupted training and examinations, 2004 48 Table 24: Obstetrics and gynaecology. .. Current Obstetrics and Gynaecology Workforce 25 Education and Training of the Obstetrics and Gynaecology Workforce 47 Adequacy of the Current Obstetrics and Gynaecology Workforce 55 Obstetrics and Gynaecology. .. survey obstetrics and gynaecology specialists, 1995 to 2001 26 Table 3: Obstetrics and gynaecology sub-specialists, 1997 and 2003 28 Table 4: Obstetrics and gynaecology specialists/sub-specialists