11 May 2022

Australia’s dermatology workforce crisis


As Australia faces a dermatology workforce shortage, the ACD hopes there is still time for it to become an election issue.

With the federal election campaign entering its final days, the Australasian College of Dermatologists has called on both sides of government to commit to increasing dermatology registrar positions as a matter of urgency.

The college also wants all parties to commit to MBS rebate reforms to “ensure they are adequate, fair and equitable, and reduce financial barriers to access for patients – specifically an increase in the attendance rebate and equity between specialities”.

College president Dr Clare Tait said with melanoma rates continuing to rise – it is estimated that two-thirds of Australians will have skin cancer by age 70 – the need has never been greater.

“In terms of having access to early diagnosis, which we know particularly for melanoma is just vital, having access to good quality, consistent, accessible and affordable health care, I think that’s a big issue for Australians,” she told Dermatology Republic.

“We’re all aware that it is very difficult for our patients to access timely and affordable care.

“We’ve fought for many years now and have been calling on increased funding for registrar positions across our public hospitals in order to have a stronger pipeline of fellows at the other end because it takes four years once you’re on the training program to become a specialist dermatologist.”

The ACD’s election statement paints a concerning picture of an already substantial nationwide shortage of dermatologists – just 590. This equates to roughly two dermatologists per 100,000 Australians.

And this shortfall is only set to get worse, according to the college statement.

“This shortage is not due to a lack of doctors seeking to train as dermatologists but inadequate public investment in dermatology services and in the registrar and consultant supervisory positions needed to grow the workforce,” it says.

“This limits ACD to graduating just 20 to 25 dermatologists per annum, far short of the number needed to grow the workforce to meet current, let alone future demand.”

“Constraints on workforce growth, maldistribution and lack of investment in public dermatology services translate into unacceptable wait times and access barriers. These access barriers are made worse by inadequate Medicare rebates for private dermatology services which increase out ofpocket costs.

“These access and equity issues urgently need to be addressed so that vulnerable Australians with skin conditions can access the specialist dermatology care they need.”

The college is asking for a $6 million investment over the next four years to fund additional training positions nationally each year.

Dr Tait said the registrars who work with consultants provide “enormously valuable health care” in the public hospital system both in the outpatient clinics and to inpatients while they’re doing their training.

“We know there have been some improvements over the last 10 to 15 years with the STP [Specialised Training Program], which has looked at funding training positions that also incorporate rural and private training opportunities,” she said.

“I think the college now has about 29 STP-funded training positions so that is helpful but still not enough. We think we need to increase our registrar numbers by probably about 50%.”

Dr Tait said the small investment of $1.5 million a year for the next four years would enable the college to graduate 30 new dermatologists each year from 2027.

“That is a tiny drop in the ocean out of the budget,” she said. “But we feel that that would make a meaningful difference to the number of dermatologists on the ground, who are able to deliver more accessible health care.”

Prior to the election announcement, the ACD did have a windfall from the federal government to pilot two projects that aim to support the training of specialist dermatologists in regional, rural and remote communities.

The projects, to run in Townsville and Darwin, will trial new ways of supporting dermatologists to deliver regional training and aim to address the issue of workforce shortage by increasing opportunities to work and train in regional, rural and remote areas.

The funding was awarded under the government’s Flexible Approach to Training in Expanded Settings (FATES) program and involved innovative approaches to training in rural and remote areas. The projects would focus on improving the learning experience for dermatology trainees while simultaneously providing access to specialist care for local communities. 

The models of training support are tailored to the unique needs of local communities and would build expertise in treating skin conditions most prevalent in those areas. The Townsville project would involve a networked model linking dermatology services at Townsville University Hospital with the Melanoma Institute of Australia in Sydney. 

This model provides Townsville-based dermatology registrars with access to ‘virtual’ supervisors, to deliver a high-risk skin cancer service for North Queensland using established telemedicine platforms. This service, using image-based melanoma detection and diagnostics, will provide Townsville and surrounding areas – areas with the highest rates of melanoma in the world – access to this expanded specialist service delivery.

Dr Aaron Boyce, who would be leading the project in Townsville said the effect would be seen straight away.

“Our community will benefit immediately from expanded services that target problems of major regional importance, such as melanoma,” he said.

“With support from Townsville University Hospital, we are also looking forward to introducing cutting edge technology into our clinics in the coming months, enabling us to detect melanoma at the earliest possible stage. This is all welcome news for the people of north Queensland, who live in a part of Australia that suffers enormously from the burden of skin cancer.”

These projects are taking steps towards combatting the workforce shortage of dermatologists outside Australia’s capital cities, Dr Boyce said.

“Regional Australia desperately needs more dermatologists, and initiatives like this not only improve services for our community today, they provide doctors in training with the positive experiences that we hope will bring them back to regional Australia the future,” he said.

“We are also showing our trainees that the quality of care provided in regional Australia is first class and that we as specialists can remain closely connected with colleagues across the country, despite the tyranny of distance.”

In Darwin, the project would involve a supervisory rotational system for specialist dermatology training. This model would increase trainee supervision and service delivery by adding visiting dermatologists to Darwin – an area with significant unmet and unique community need.

This increased capacity would provide Royal Darwin Hospital with additional consultant dermatologist supervision and build capacity for a rural training centre, where trainees can build knowledge and expertise in Indigenous, tropical and rural dermatology.

Dr Dev Tilakaratne who will be leading the project in Darwin said the project would improve capacity to increase outreach service provision to remote communities outside of the greater Darwin area.

The focus on bringing additional supervisors to Darwin is designed to increase the knowledge of the trainee dermatologists, as well as increase the services available to the local community.

“Having the synergy of several dermatologists providing services in the Northern Territory, each with a unique skill set and areas of special interest will bring us one step closer to having a stable dermatology workforce, by improving service provision for patients and by providing comprehensive supervision for the trainee dermatologists and support for the existing dermatologists servicing Darwin,” Dr Tilakaratne said.