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You might be aware of the dreadful state of the United Kingdom’s once-vaunted National Health Service, which, in an environment of serious fiscal constraint, high demand and a shortage of doctors, is increasingly turning to all manner of non-medically trained health workers to (in some cases) autonomously perform roles traditionally, and arguably more suitably, performed by doctors. Notwithstanding the current challenges facing the private healthcare sector in Australia, we have a much healthier competitive mix of private and public health services, protecting us somewhat from this situation. But we face the same uncontrollable factors of an ageing population, increasing co-morbidity and complexity, and rising costs of medical technology.    

We also suffer the same shortage of doctors as many countries have globally; this is not beyond our control. The biggest single argument and driver for governments to permit lower standards of healthcare by role substitution is shortages in the incumbent workforce. We do not have enough doctors. We have been reliant since time immemorial on doctors from overseas, who provide excellent service to their new communities, but are increasingly difficult to find.    

Clearly, we need to train more doctors. But what does this look like in the ever-shifting sands of medical workforce data and reviews? There is a strong argument that we have a workforce distribution and training pipeline problem. Whether we graduate enough doctors is not as certain, and in any case increasing medical student numbers has to be coupled with system-wide reform of how we train specialists including GPs, and provide non-specialist hospital- and community-based care.    

Some will have been bemused a couple of weeks ago by the sight of pharmacists accessorised with stethoscopes standing alongside politicians in Queensland as they announced their increased scope of practice program (misleadingly referred to by its proponents as “full scope” or “top of scope,” as though it has been government regulation, rather than a complete lack of training, preventing pharmacists doing such things as interpreting physical signs). We can, and should, continue to oppose any unsafe or unproven expansion of services by non-medical practitioners; but we have a uniquely powerful pharmacy lobby in this country, which should also cause us to reflect on ways in which we can innovate to improve the provision of care and remain ahead of the game, rather than constantly fighting a rearguard action.

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