Principles for the Post-COVID-19 Pandemic Medical Workforce

This is a position statement of the Royal Australasian College of Medical Administrators which has been prepared to provide guidance to the public, profession and jurisdictions.

The COVID-19 Pandemic, like Spanish flu and previous pandemics, has had major impacts on the Australian and New Zealand communities and their economies. Through expert leadership, Australia and New Zealand have limited the extent of COVID in our communities, and to date have not been as badly affected as many other countries. We have learned important lessons about health service provision and health workforce capabilities which can inform future decision-making.

The need to respond effectively and efficiently to the pandemic has resulted in new models of health care, including telehealth for consultations, improved electronic communication between health professionals, re-activation of hitherto underutilised means of supporting isolated at-risk members of the community, innovative health workforce redeployment and rapid credentialing processes to ensure there is adequate clinicians to meet anticipated demand.

As advocates for leadership and strategic planning in the interests of safety of our patients and the community, RACMA considers the following principles must be considered to shape any review of the future medical workforce.

Systems Approach
1. Genuine partnering with consumers and First Nations peoples

There must be more recognition of the value of partnering with consumers, including acknowledging the heterogeneity of their individual capacities, interactions, experiences and preferences in healthcare.

Healthcare planning and decision making must be done in genuine partnership with our Māori and Aboriginal and Torres Strait Islander First Nations peoples.

It will be important for medical practitioners – generalists and specialists – to join their nursing and allied health professionals more frequently in providing preventative, acute and follow up care in ways, and in settings, which are useful for their patients.

2. Adopting a whole of system approach
Medical workforce planning needs to be cognisant of, and respond to, maldistributions; and integral to policy-making which ensures seamlessness across public, private and community care; and where possible across city, regional and rural practice.

3. Provision of health services based on skills rather than traditional roles
The skills and training of all health professionals will be recognised, and activity delineations will be costed against competencies and effectiveness. Health practitioners should be practising the top of their scope of clinical practice, to address workforce shortages and reduce the burden of increasing costs to the health system, with a focus on clinical outcomes.

4. Medical practitioner involvement in clinical governance
All medical practitioners must be trained in and understand their central role and contribution to clinical governance, and to the continued improvement of quality, safety and patient experience in healthcare.

Innovation and Change
5. Opportunity to maintain and sustain innovative changes
We must learn from the crisis, embracing the emergency enhancements which have been successful, seriously challenging and reviewing our current workforce practices, and defining the training needed for the “future normal”.

We must continue to build on what has been achieved with the greater integration of the different sectors in health, such as Primary Health Networks, hospitals, primary and community health, as well as increasing the role of general practitioners in the system, coordination of care across specialties and different sites, and recognising the importance of integrated care.

The “future normal” will include expanding telehealth services, and embracing automation including the use of artificial intelligence (AI) and other technologies.

6. Continued development of digital health
Digital health is an essential part of healthcare. All medical practitioners need to be trained and provided with opportunities for learning in digital health developments including patient applications, distance monitoring and delivery of care, internet services and the use of electronic data, data security and privacy and risk management. This will ensure that the care they provide is purposeful and valued.

7. Establish a true 24/7 health service provision model in acute health
There is an urgent need to challenge conventional, apparently inflexible, industrial systems where they provide barriers to provision of adaptive and high-quality critical care. Hospital care needs to be provided consistently after-hours and over weekends with dedicated consultant presence, especially in acute and critical care areas.

Support and Education
8. Increased support for training of medical practitioners in the principles of ethical public health management
It will be important that future training of medical practitioners incorporates greater awareness of public health management as a competency and specifically the unique roles of medical practitioners in emergency responses, at all levels. It will also be important for reiteration and discussion of ethical decision-making principles to be incorporated in training of medical practitioners and updated decision-making processes to be regularly presented as continuing professional development options.

9. Review of medical education
Novel methods for learning and assessment of face-to-face history-taking, physical examination, investigation, reasoning and intervention will be needed.

The value of electronic services will continue to be acknowledged and renewed in all medical education – in pre-vocational and specialty training and in post-graduate continuing education – as well as in assessment of competency. Embracing e-Education will be important for this activity and will assist in the timeliness of the incorporation of the lessons learned.

Research and Evaluation
10. Utilisation of the outcomes of Health Service Research
The quantification of the medical workforce responses, difficulties and successes, by supported health service research, will inform planning for useful workforce changes.

Data on medical services and outcomes should inform a focus on identification of duplication and waste, and their elimination.

23 June 2020

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