Cash injection needed to tackle dermatology workforce shortage


By Heather Wiseman

17 Oct 2018

State and territory governments must together contribute at least $1.2M each year to specialist dermatologist training if a shortfall of 90 specialists by 2030 is to be prevented, the Australasian College of Dermatology has warned.

President Dr Andrew Miller told the limbic at least eight more medical registrar positions are needed each year in order to overcome shortages predicted by the Department of Health. While rural and remote areas were affected, at this stage shortages were biting hard in outer metropolitan Sydney.

“We should be aiming at about 1.8 full time equivalent dermatologists per 100,000 population, and in Western Sydney it is down to about 0.7,” he said.

“Everywhere else in NSW [outside Sydney] is 0.9 FTE which is about half of what it should be.”

He said even in the ACT, where he works, the only specialist training position is federally funded “and the ratio is hovering at about 0.8; well under half the workforce needed”.

Of the 31 towns in Australia with a population greater than 55,000, most don’t have a public dermatologist and bulk billing rates were not an adequate incentive for private dermatologists to take on the work.

“That’s why we need public hospital services,” Dr Miller said.

The Australasian College of Dermatology (ACD) was grateful that the Federal Government funded 27 training positions each year, but their distribution was compromised because the Commonwealth was not the direct service provider.

He gave the example of the Queensland Sunshine Coast; an area of significant population growth which achieved federally funded training positions because it was classified as rural.

“Recently the area has been reclassified as urban, so we can no longer have the federally subsidised training there, even though there is a critical shortage of dermatologists in that area.”

Mr Miller said the reasons underpinning shortages varied state to state, and the ACD was trying to find tailored solutions, including training specialist nurses and GPs to manage more straightforward conditions.

The common issue however was state and territory governments’ resistance to both training and employing specialist dermatologists, which represented false economy and outpatient services with “inappropriately long waiting lists”.

“In hospitals that don’t have dermatologists, they have other doctors who do the work but the evidence shows that they don’t do it as well or as efficiently,” he said.

“If you look at survival rates or inpatient stay time you’ll see that if dermatologists are managing these patients stay times are shorter.”

He said there were clear opportunities for public hospitals like Hawkesbury Hospital and Campbelltown Hospital, which had no dermatology unit.

“The training opportunities for those sites would be spectacular because the clinical load is so great,” he said.

Without adequate public access, people who could not afford private care for complex needs or comorbidities waited months and months to see a dermatologist, which was “completely inappropriate and a great frustration to all of my colleagues,” he added.

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