Non-registered health professions
Many people employed in the health sector work in occupations that are not registered by Ahpra and there are fewer available data for these groups. These members of the health workforce still play an important role in delivering health services to Australians and include, for example, dieticians, clerical workers, health information managers, welfare professionals, service workers, cleaners, and gardeners. Also, some health professionals (such as dietician, audiologist, speech pathologist, etc.) are self-regulated by their professional association to ensure that high safety and quality standards are maintained.
According to the Australian Bureau of Statistics (ABS) 2016 Census of Population and Housing – more than 820,000 people reported working in the health services industry (ABS 2021a). Outside of the Ahpra-registered professions, this included around 13,200 ambulance officers and paramedics (note that paramedicine practitioners were then listed as a new registered health profession in 2019 data); 21,000 medical technicians; 21,000 dental assistants; and 26,100 nursing support and personal care workers. The ABS will complete the 2021 Census of Population and Housing in June 2022 (ABS 2021b).
Impact of the COVID-19 pandemic on the health workforce
At the time of writing, the COVID-19 pandemic continues. Many of Australia’s healthcare workforce are on the frontline and continue to be impacted by the pandemic in different ways. However, as data related to COVID-19 impacts are limited and obtained from small-sized surveys, the following results should be interpreted with caution.
The pandemic has affected the physical health of workers. A report of 2,163 healthcare workers during January and September 2020 indicated that in the second wave of the pandemic, when there was heightened community transmission, health care workers were more likely to be infected in the workplace and nurses were more likely to be infected than staff in other roles (Rafferty et al. 2021). Quigley et al. (2021) using data from January to July 2020 of 36 hospital outbreaks concluded that the infection rate of health workers was 2.7 times higher than community infection.
In terms of mental health, healthcare workers exhibit higher rates of anxiety, depression and suicidal ideation when compared to the general population (Beyondblue 2019). During emergencies like we have experienced during COVID-19, increased posttraumatic stress disorder (PTSD), anxiety and depression could be observed in healthcare workers (Shah et al. 2020). Some pandemic-related stress on healthcare workers is also evident (Aggar et al. 2021; Dobson et al. 2020; Holton et al. 2021; Pascoe et al. 2021; Smallwood et al. 2021a).
Some evidence suggested that the pandemic had increased the workload of health workers. An online survey of 7,846 frontline health workers conducted by Smallwood et al. (2021b) between August and October 2020 indicated that 21.5% increased their unpaid work hours, 20.8% of respondents increased their paid work hours, 16.8% were redeployed to a new work area, and 27.3% changed their work role.
Between 2015 and 2019, the share of foreign-trained doctors and nurses were almost unchanged (32% and 18% respectively, see OECD 2022). However, the international travel restrictions due to the pandemic might affect these shares. This is to be confirmed when updated data become available.
Some of the measures used to cope with COVID-19 in the healthcare sector
Pandemic response sub-register
At the onset of COVID-19, the Ahpra and the relevant National Boards established a temporary pandemic response sub-register up to 12 months in April 2020 (the 2020 sub-register) to help fast track the return to the workforce of experienced and qualified health practitioners. In early April 2021, the Commonwealth Health Minister requested that medical practitioners, nurses, midwives, and pharmacists be extended to stay on the sub-register for up to 12 months (to 5 April 2022) to help with the COVID-19 vaccination program only. This was also the case for Aboriginal and Torres Strait Islander Health Practitioners. On 8 September 2021, the registration of practitioners on the 2020 sub-register was changed so they could work in any area supporting the COVID-19 response. On 22 September 2021, Ahpra and the relevant National Boards established a new sub-register (the 2021 sub-register), for practitioners in 12 regulated health professions to return to practice for up to 12 months, working to the full scope of their registration. As of 22 December 2021, there were 23,307 health professionals on the 2020 pandemic response sub-register and 20,860 health professionals on the 2021 pandemic response sub-register (Ahpra 2021b).
Inclusion of Telehealth in Medicare Benefits Schedule
In March 2020, the Australian Government introduced new Medicare Benefits Schedule (MBS) funding so that specialists (and other clinicians) could provide telehealth consultations. Compared to the pre-existing funding, access to COVID-19 MBS telehealth funding was not geographically restricted. MBS reimbursement of specialist telehealth consultations was further extended to include telephone consultations in addition to video consultations. The temporary MBS telehealth items are available to general practitioners, medical practitioners, specialists, consultant physicians, nurse practitioners, participating midwives, allied health providers and dental practitioners in the practice of oral and maxillofacial surgery (Department of Health 2021a). From 1 January 2022, patient access to telehealth services has been supported by ongoing MBS arrangements which enable all Medicare eligible Australians to access telehealth (video and phone) services for a range of (out of hospital) consultations that can also be provided in person (Department of Health 2021c). Between March 2020 and December 2021, 87 million telehealth services were delivered to 16.2 million patients, with more than $4.4 billion in benefits paid and 89,180 practitioners having now used telehealth services (Australian Digital Health Agency 2021).
Mental Health support for healthcare workers
The Australian Government also funds tailored mental health supports for the health workforce. This includes implementing Every Doctor, Every Setting, a national framework to deliver a coordinated approach to support the mental health of doctors and medical students; The Essential Network (TEN) project, a multifaceted e-health hub, delivered by the Black Dog Institute for healthcare professionals by healthcare professionals; and DRS4DRS service which provides mental health consultations for doctors and medical students.
Elective surgery restrictions
Following a decision by National Cabinet, in the context of ensuring the health system maintained adequate capacity to deal with the COVID-19 pandemic, restrictions were applied to selected elective surgeries from 26 March 2020.
Under these restrictions, only Category 1 and exceptional Category 2 procedures could be undertaken. These restrictions were eased (but not fully lifted) from 29 April 2020, allowing all Category 2 and some important Category 3 procedures to be performed. In early January 2022, to help hospitals respond to the increasing number of patients with Omicron strain COVID-19, some states and territories such as New South Wales, Victoria, Queensland, South Australia reapplied temporary elective surgery suspensions (New South Wales Government 2022; Victoria Department of Health 2022; Queensland Government 2022; South Australia 2022). These restrictions resulted in delays to many types of elective surgery, waiting times for most intended procedures increased. The proportion of patients waiting more than 365 days for their elective surgery rose between 2019–20 and 2020–21 overall from 2.8% to 7.6% (AIHW 2021).
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