A national shortage of palliative medicine physicians is leaving tens of thousands of terminally ill patients without adequate end-of-life care, figures suggest.
The ageing population is driving demand for services, with a 10% year-on-year increase in MBS-subsidised palliative care services in the five years to 2015.
Expert groups are warning that demand outstrips supply with a national workforce of just 213 palliative care specialists, representing an average of 0.9 FTE per 100,000, less than the minimum recommended by the Australian and New Zealand Society of Palliative Medicine.
The situation is dire, according to Palliative Care Australia (PCA), which has called on the federal government to urgently fund more specialist trainee positions.
There is one palliative medicine physician for every 740 deaths [per year], PCA says in a pre-budget submission, which calls for the appointment of a palliative care commissioner and a national strategy.
The access problem is worsened by uneven workforce distribution, with 84% of specialists working mainly in major cities. State-to-state distribution is also uneven, with Tasmania having a ratio of 1.8 FTE specialists per 100,000, while Victoria has just 0.7.
This means for many “access to community-based palliative care is determined by where they live, rather than where they would prefer to die”.
PCA chief executive Liz Calligan says an estimated 80,000 people are missing out on needed palliative care annually.
“We have around 160,000 deaths per year, and three quarters are expected from malignant or non-malignant chronic disease.
“You could say those people would benefit from access to palliative care. That leaves 120,000 could benefit from accessing it and at the moment palliative care physicians have consulted with 40,000 so that means around 80,000 are missing out on specialist palliative care – they might be getting some, but it’s very hard to quantify.”
Another issue is that palliative medicine physicians can’t provide MBS-subsidised inpatient case conferencing or family meetings, which other specialists can.
Australian and New Zealand Society of Palliative Medicine president Professor Meera Agar says that in some areas, it is difficult to provide patients with seamless care provision due to restrictive employment arrangements that prevent salaried doctors and palliative care case-managers delivering care across home, hospital and outpatient settings.
ANZSPM recommends a minimum ratio of 1 FTE palliative medicine physician per 100,000 patients, but Professor Agar says a higher ratio may be needed in rural areas where one physician covers a large geographical area, unless telehealth and other innovative models are more widely adopted.
As for just how many more physicians are needed to fill the workforce gap, the PCA hopes to answer that question when it releases modelling next month.
In 2014-15 65,000 of hospitalisations were palliative care related and 46% of patients who died as an admitted patient received palliative care.
In 2015, 99 doctors undertook palliative care physician training, the majority in adult medicine, and there was a 550% increase in new RACP fellows in the five years to 2014, according to a report by the Australian Institute of Health and Welfare.
“At present, the number of people wishing to die at home with the support of a community-based palliative care service far exceeds the availability of that care, particularly for those with illnesses other than cancer,” the PCA submission concludes.
“PCA draws attention to (a)…Productivity Commission Draft Report released in June 2017, which states that ‘without significant policy reform, tens of thousands of Australians will die in a way and in a place that does not reflect their values or their choices”.