The Australian Government’s Department of Health Disability and Aging has published an important report called The Psychiatry Supply and Demand Study (PSDS).
The PSDS is a health workforce model which projects levels of supply and demand of Psychiatrists in Australia between the years 2024-2048.
Before we look closely at some of the model's outcomes lets look at statistics which the study threw up which provide a useful snapshot of psychiatrists working in Australia:
Headcount: 4,272.
Average Weekly hours: 35.7
Public FTE: 51.2%
Major city location: 85.6%
Average age: 52.6
Female: 42.9%
Specialist training gained in Australia or New Zealand: 74.7%.
3 things here stand out for me. Number of females, the average weekly hours worked and the number of psychiatrists who work in major cities.
The statistics and variances for State and Territories can be very interesting. Which state or territory do you think has the highest percentage of female psychiatrists? The Australian Capital Territory (ACT) has the highest - 51.3%. Tasmania had the lowest percentage of females with only 37.4%.
South Australia had the highest % of psychiatrists working in a major city: 96.9% (apart from ACT where the only location is Canberra so they obviously have 100% working in a major city).
The psychiatry workforce has grown from 3,417.8 FTE psychiatrists in 2019 to 3,812.6 in 2023 - an inrease of 2.8% (CAGR).
Over the last 5 years, the proportion of FTE psychiatrists working in the public sector has increased slightly (from 50.6% in 2019 to 51.2% in 2023) due to slightly higher growth in the public sector headcount.
The PSDS study’s aims is to improve the understanding of the workforce challenges by providing important data to help guide policy decisions on regulating psychiatry specialist training places, and the distribution of Specialist International Medical Graduates (SIMGs) across Australia.
The study did this by quantifying projected demand and supply of psychiatrists from 2024 to 2048, using data collected between 2014 and 2023.
The PSDS model also projected levels of 'unmet demand'. Unmet demand for psychiatry services occurs when there are not enough services to meet the needs of the catchment population.
On supply issues, the study looked at current psychiatrist numbers, studied their demographics and historical work pattern. It projected the numbers of new fellows each year and the number of SIMG psychiatrists entering Australia, illustrated in my table below:
This graph illustrates 2018-2048 FTE psychiatrists : national supply versus demand:
At a State and Territory level, all are projected to be in shortage (with both baseline demand and unmet demand). Larger states have the highest gap in FTE workforce 2024-2048. When comparing numbers to percentage shortfall (using unmet demand), the Northern territory has the highest shortage at 83.8% and Victoria and South Australia have the lowest shortage at around 9.6% in 2024.
The key takeaway from the PSDS is that Australia will continue to have a significant gap in the specialist psychiatric workforce until 2048.
The baseline demand projections for FTE that the study makes, indicate 2.7% undersupply in 2024, peaking to 7.4% in 2033, before declining to 4.3% in 2048.
However, considering unmet demand, the study’s findings identify a much higher shortage of psychiatrists across Australia. Projections indicate a 19.6% undersupply of psychiatrists in 2024, which is expected to widen to 20.7% by 2048.
AHPRA implemented the new Expedited Specialist Pathway for Psychiatry in December 2024 and the college RANZCP now has the Accelerated Pathway in place. I wonder if these two worthwhile programs will make a difference to these projected numbers. At the moment, these two pathways only make it easier for UK trained psychiatrists to get specialist assessement and/or specialist registration. Whether these prove to be initiatives which increase the flow of psychiatrists significantly into Australia is yet to be determined. However, I believe that until these pathways are extended to other countries of training the numbers of SIMGS into Australia will remain relatively steady and not see the increased numbers policy makers hope so.
Notably, the study says that Australia’s reliance on SIMG psychiatrists will decline, dropping from 26.3% of the psychiatry workforce in 2024 to 18.3% by 2048.
SIMGs typically contribute higher average FTE compared to equivalent locally trained psychiatrists. However, over the projection period, the average FTE for the SIMGs is expected to decline from 0.92 in 2024 to 0.83 in 2048, while the average FTE for locally trained psychiatrists will see a more modest decrease, from 0.86 in 2024 to 0.83 in 2048.
The study also highlights a trend towards psychiatrists working fewer hours over time with the projections suggesting average FTE will decline from 0.88 in 2024 to 0.83 in 2048. This shift is likely driven by the changes projected for the SIMG workforce around its growth and average FTE.
The study illustrates the impact of the aging workforce. The proportion of FTE contributed by the 55–64 years old cohort is expected to rise from 23% in 2024 to 28% by 2048. This cohort is also expected to keep providing the most FTE per psychiatrists alongside the 40–54 years old cohort throughout the period 2024 - 2048.
Sadly, the report also noted that in 2023, 85% of FTE psychiatrists were located in metropolitan areas with only 1.8% in rural and remote areas. The study says “ Evidence suggests that Australia relies on overseas trained psychiatrists to meet the workforce need, particularly in rural, regional and remote areas with an increasing proportion of overseas trained psychiatrists working in these areas.”
Overall, the study concludes that whilst it is great to see that the number of new psychiatrists entering the workforce is rising, it’s not increasing enough to match the growing demand for services - especially when considering the unmet demand issue.
The PSDS study states that as the psychiatry workforce continues to get older and likely to work less hours in the future, addressing these looming workforce shortages will require significant reforms to Australia’s psychiatric training system, as well as initiatives to better utilise other stakeholders in the mental health sector to help ease the pressure and help provide care to the Aussie population.
From my own perspective where I recruit SIMGs and FRANZCP to mental health services around Australia. I would also say that further reforms to the RANZCP SIMG specialist assessment process will also help to ease this pressure. Direct entry permanent residency visas into rural and regional areas could also be a way to help address the psychiatry discrepancies between city and country. Other initiatives naturally include additional allowances, awarded to psychiatrists moving to areas where there are workforce shortages.
What do you think?
If you have specific questions about the workforce please contact me. You can email me alasdair@spinnermedical.com or message/Whatsapp/Signal +447414531583
Source: Australian Government: Department of Health, Disability and Ageing.