Palliative care services in Australia

In 2020, 279 full-time equivalent (FTE) palliative medicine physicians and 3,279 FTE palliative care nurses were employed in Australia. This section provides information on the number and characteristics of the employed workforce of physicians with a primary specialty of palliative medicine (referred to as ‘palliative medicine physicians’) and nurses working in palliative care (referred to as ‘palliative care nurses’). 

This information was sourced from the National Health Workforce Dataset (NHWDS) for the period 2016 to 2020 and only includes medical practitioners and nurses, as these professionals can be specifically identified as palliative care providers using the Department of Health’s Health Workforce Data Tool (HWDT).

However, the palliative care workforce is made up of a broad range of professional groups, each playing a unique role in supporting people with a life limiting illness to receive comprehensive, patient-centred care. It is recognised that general practitioners, other medical specialists, social workers, occupational therapists, physiotherapists, and other allied health professionals form an integral part of the palliative care workforce. However, existing national data sources are not able to accurately capture the extent of palliative care services provided by these health professionals. See Data Sources section for further details.

The information in this section was last updated in October 2022.

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Who provides specialist palliative care services?

In 2020, there were 302 palliative medicine physicians (279 FTE) and 3,798 palliative care nurses (3,279 FTE) employed in Australia, accounting for 0.8% of all employed specialist medical practitioners and 1.1% of all employed nurses and midwives.

Of the 3,798 palliative care nurses, over 4 in 5 (85% or 3,220) were registered nurses and 15% (578) were enrolled nurses (only). In addition, 80 nurse practitioners (70 of whom were actually employed as a nurse practitioner worked in palliative care in 2020 (see Physicians and nurses specialising in palliative care for further details).

In addition, there were 6 paediatric palliative medicine physicians in Australia in 2020 (MBA 2020), making up 0.2% of all physicians with a primary speciality of paediatrics and child health (3,333).

Nurse practitioners and paediatric physicians are not included in the numbers presented here.

In 2020, for employed palliative medicine physicians and palliative care nurses:

• Most were women – almost 2 in 3 (64%) palliative medicine physicians were women, which was almost twice as high as for all employed specialist medical practitioners (35%); and 9 in 10 (92%) palliative care nurses were women, which is slightly higher than the proportion among all employed nurses and midwives (88%) (Tables Wk.1–2).
• Female palliative medicine physicians were younger than male palliative medicine physicians (78% and 63% were aged under 55, respectively); however, female palliative care nurses were older than male palliative care nurses (32% and 20% were aged 55 and over, respectively) (Tables Wk.1–2).

• The 35–44 age group was the peak age group of palliative medicine physicians (40%), with the number of physicians then declining with increasing age, from 28% at age 45–54, to 10% for those aged 65 and over. While for palliative care nurses, the proportion was more evenly distributed across the age groups, increasing from about 20% for 20–44 age group to 26–28% for those aged 45–64, and then declining to 4.6% for those aged 65 and over (Figure Wk.1).
• The rate of palliative medicine physicians (FTE per 100,000 population) ranged from 0.6 in Western Australia to 1.8 in Tasmania (data are not presented for Australian Capital Territory and North Territory due to small numbers). For palliative care nurses, the rate ranged from 0.1 in the Northern Territory to 3.8 per 100,000 population in New South Wales ( Figure Wk.1). 
• More than half of palliative medicine physicians and palliative care nurses worked in a hospital setting (75% and 56%, respectively) and most were principally employed as clinicians (92% for palliative medicine physicians and 96% for palliative care nurses respectively) (Figure Wk.1).

Figure WK.1: Characteristics of employed palliative medicine physicians and palliative care nurses, 2020

How long did they work each week?

In 2020, for employed palliative medicine physicians and palliative care nurses:

• Palliative medicine physicians worked an average of 37 total hours per week (29 clinical hours), which was less than the average weekly hours for all employed specialist medical practitioners (41 total hours and 34 clinical hours; Table Wk.3).
• Palliative care nurses worked an average of 33 total hours (31 clinical hours), similar to that worked by all employed nurses and midwives (33 total hours and 30 clinical hours).
• Men worked longer hours on average per week than women both for palliative medicine physicians (40 compared with 35 total hours) and palliative care nurses (35 compared with 33 total hours), consistent with the pattern observed for all employed specialist medical practitioners and all employed nurses and midwives.
• For palliative medicine physicians, the average hours worked varied by state and territory, ranging from 32 total hours per week in Victoria to 43 total hours in Tasmania (Figure Wk.2) (data are not presented for Australian Capital Territory and Northern Territory due to small counts).
• For palliative care nurses, hours worked per week ranged from 31 total hours in Victoria, South Australia and Tasmania, to 36 total hours in Northern Territory (Figure Wk.2).
• Administrators (as their principal role) had the longest working hours per week, with an average of 48 and 36 total hours per week for palliative medicine physicians and palliative care nurses, respectively (Figure Wk.2).
• Palliative medicine physicians worked on average 34–38 total hours per week across most work settings, except for those in tertiary education facilities who worked on average of 45 total hours per week (however this is based on very small counts with only 5 palliative medicine physicians working in this setting).
• Palliative care nurses working in outpatient services had the longest working hours per week (36 total hours), while those working in independent private practice had the shortest hours per week (19 total hours; Figure Wk.2).

Note, data are not presented for all settings due to small numbers – palliative medicine physicians data for residential aged care facility and other government department or agency and palliative care nurses data for commercial/business service and other educational facility are not presented.
 

Figure Wk.2: Average hours worked per week by employed palliative medicine physicians and palliative care nurses, 2020

How has the palliative care workforce changed over time, including during the COVID-19 pandemic?

Between 2016 and 2020, there was an increase in palliative medicine physicians and palliative care nurses, with the rate of increase steeper for physicians than for nurses. The number of employed palliative medicine physicians increased by 29%, from 234 to 302. This increase was steeper than that observed for all employed specialist medical practitioners (17% increase). For employed palliative care nurses, there was an overall increase of 9.5% over this period (from 3,469 to 3,798), with the increase steeper for registered nurses than enrolled nurses (11% compared with 1% increase, respectively). This overall increase in palliative care nurses was relatively similar to that observed for all employed nurses and midwives (11% increase) (Table Wk.1–2).  

After accounting for population size, the rate of FTE palliative medicine physicians and palliative care nurses also increased slightly over the 5-year period from 2016 to 2020 – for palliative medicine physicians from 0.9 FTE (0.7 clinical FTE) to 1.1 (0.8 clinical FTE) per 100,000 population between 2016 and 2020, and for palliative care nurses the corresponding increase was from 12.2 FTE (11.3 clinical FTE) to 12.8 FTE (12.0 clinical FTE) (Figure Wk.3).

Over the 5-year period from 2016 to 2020, women accounted for 68% of the increase in palliative medicine physicians (an increase from 147 to 193 for female physicians, compared with 87 to 109 for males). Around 70–75% of female palliative medicine physicians were aged 35–54 and this remained relatively stable over the 5 years to 2020. Interestingly, the proportion of male physicians aged 35–54 increased from 44% in 2016 to 58% in 2020 (Figure Wk.3).  

While most palliative care nurses were women (92%), there was a steeper increase in male nurses than female nurses between 2016 and 2020 – 35% compared with 7.6% increase, respectively. The largest increases for male nurses were among those aged under 35 (57% increase), which was 3 times as steep as for female nurses of the same age group (17% increase) (Table Wk.2).

The number of palliative care nurses that identified as Aboriginal and/or Torres Strait Islander has been steadily increasing since 2016 – from 28 to 49 between 2016 and 2020. This rate of increase (75%) was steeper than that for non-Indigenous palliative care nurses and all employed Indigenous nurses and midwives over this period (8.9% and 48%, respectively) (Table Wk.2).

The average number of total hours worked has declined slightly for palliative medicine physicians (from 39 to 37 hours) between 2016 and 2020. For palliative care nurses’ average hours worked has remained relatively stable (around 33 hours) over the same period (Figure Wk.3).

Impacts of the COVID-19 pandemic

The COVID-19 pandemic has presented many challenges, especially for the health and aged care workforce. Frontline healthcare workers have been central to the pandemic response and, like many, have had to adjust to different ways of working.

Although the number of palliative medicine physicians increased each year from 2016 to 2020, the rate of increase more than halved between 2019 and 2020 (3.4% increase) when compared to increases observed in previous years (7.7%–8.8% annual increases between 2017–2018 and 2018–2019; Figure Wk.3). This pattern was consistent with all employed specialist medical practitioners, where the rate of increase was slower in 2020 than in previous years (3.4% increase between 2019 and 2020 compared with 5.2–5.3% increases between 2016–2017 and 2018–2019).

In contrast, the rate of increase remained relatively stable for the number of palliative care nurses over the years from 2017–2020 (around 3–4% per year), despite the increase for all employed nurses and midwives slowing in 2020 compared with previous years (1% increase between 2019 and 2020 compared with 3% increase in the 2 years prior 2019; Figure Wk.3).

These data suggest that the effect of the public health response to the COVID-19 pandemic appears to have had a larger impact on employed palliative medicine physicians (and all employed specialist medical practitioners and employed nurses and midwives) than for palliative care nurses.  However, more data over a longer period is needed to provide insights on the effects of the COVID-19 pandemic on the palliative care workforce.

Figure Wk.3: Trends in the number of employed palliative medicine physicians and palliative care nurses, 2016–2020