Key findings and trends
Growth of the medical workforce and increased competition
- The medical workforce continues to expand at 5.3 percent per year: 2.7 per cent above population growth.
- Junior doctor numbers have increased by 8.9 percent per year since 2005. Increased supply can lead to greater competition within the training pipeline and through to unsupervised clinical public and private practice.
- A more competitive career ladder creates incentives for increased effort to reach fellowship, while at the same time increasing the proportion of doctors who might change their career goals or even exit the profession. This is placing increased pressure on junior doctors who are reporting burnout, stress, mental health problems, bullying and discrimination. Though these pressures have existed for a long time, additional competition is unlikely to be helping. An improved culture could increase productivity, team work and patient safety.
- Policy responses are aimed at making effective use of the increased doctor supply by improving the distribution of doctors and reducing reliance on international medical graduates (IMGs).
Earnings on the rise
- Although supply is increasing, doctors’ earnings are growing at 1.8 per cent per year above inflation, with increases across all doctor types, most age groups, for males and females, and across most specialties. Doctors’ earnings are unlikely to fall due to increased supply as long as demand for healthcare continues to increase.
- The gap in earnings between females and males is relatively constant with some evidence of narrowing since 2016. The growth in earnings for females aged over 45 is faster than that of males, who, unlike females, have been reducing their average hours of work. The gender gap in earnings could fall as more women complete training and if efforts to drive culture and improvements in gender equality succeed.
Impact on the private medical sector
- The increased supply of doctors is most likely to be absorbed by the private sector, rather than budget-constrained public hospitals. However, this depends on the community’s perception of the value of private sector healthcare, with recent evidence showing a slowdown in the use of private hospitals.
- Private medical practices might respond to increased competition through consolidation, though this could also reduce consumer choice and raise prices as competition falls. The future could involve tighter regulation of the sector if this balance is seen to disadvantage patients.
Facing a digital age
- Technological change holds much promise for increasing the productivity of healthcare by improving information flows and better use of data, and by bringing doctors and patients together online to improve access to medical care. However, a number of barriers to change and uptake in the short-term will need to be resolved before benefits can be realised.
In the future a larger, and so more expensive, medical workforce is likely to face increased competition, along with increasing pressures from within to change cultures and demonstrate improved value and productivity for patients, governments and private health insurers. Technology (and better information) needs to be used cautiously to ensure it can support the medical workforce in achieving this.