Understanding the Dynamics of the Medical Workforce: The MABEL Longitudinal Survey of Doctors Medici

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Understanding the Dynamics of the Medical
WorkforceThe MABEL Longitudinal Survey of
DoctorsMedicine in Australia Balancing
Employment and Life (MABEL) Prof. Anthony
Scott1, Dr. Catherine Joyce2, Prof. John
Humphreys2, A/Prof. Guyonne Kalb1, Dr. Julia
Witt1, Dr. Sung-hee Jeon1, Ms. Anne Leahy11.
The University of Melbourne, Australia2. Monash
University, Australia Funding National Health
and Medical Research Council
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Outline

• Australian context
• About MABEL
• Key research questions
• Methods
• Where are we at?

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Australian context

• 56,000 doctors (283/100,000 population)
• Wide regional variation
• Fee-for-service
• Free to practice in any location
• Free to charge patients what they like (with a
  rebate from Medicare)
• Falling hours of work increasing proportion of
  women falling participation rates baby
  boomers retiring recent expansions of medical
  school places growth in specialist numbers but
  not GPs.
• Inequitable distribution between urban and
  rural/remote areas
• 37 overseas trained doctors
• Most are male, Australian born, in solo practice

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About MABEL

• Funded for 5 years - April 2007 to March 2011
• 4 annual waves beginning in May 2008
• Funding to cover surveys running costs as well
  as research and analysis of data
• Emphasis on knowledge transfer, policy relevance,
  and capacity building.

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How will MABEL complement other surveys?

• Most other surveys
• are descriptive and focus on numbers
• focus only on graduates or doctors in training
• are cross-sectional
• are not based on a theoretical framework
• MABEL will
• examine why doctors change their hours of work,
  jobs, location etc
• be longitudinal and use a large sample
• focus on trained doctors (from training to
  retirement)
• evaluate and simulate the effects of policy
  change
• use a strong theoretical framework

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Key questions/issues

• Why do doctors change their labour supply?
• What factors influence changes in
• hours of work?
• participation?
• retirement?
• mobility?
• specialty choice?
• balance between public and private sector work?
• job satisfaction?
• How do changes in labour supply influence access
  to health care, medical practice patterns, and
  health care costs?
• What policies and incentives influence labour
  supply decisions?

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Methods

• Stratified random sample
• Doctor type, geographic area
• Personal invite letter sent by post
• Randomised trial comparing response modes
• online vs. hardcopy vs. mixed mode
• each group can also choose to complete the survey
  using another mode
• 100 (US92) cheque with invite letter for those
  in remote/rural areas
• Reminder letter after 3 weeks
• Publicity and endorsements

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Population of doctors in Australia (sampling
frame)
Source AMPCo Masterfile, November 2007.
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Methods

• Face-to-face piloting
• Two online pilots in late 2007
• Third pilot currently underway
• First wave in middle of May 2008
• Questionnaires (4 versions)
• Job characteristics and attitudes
• Discrete choice experiment
• Working patterns
• Earnings
• Demographics
• Family and household

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Discrete choice experiment (example)
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Findings to date.

• Response rates for two online pilots in 2007
• 10
• No reminder, little publicity, no endorsements
• Third pilot
• Reminder, shorter questionnaire, more publicity,
  no endorsements
• 24 doctors sent 100 cheque with 60 response
  rate so far
• For remainder of sample, response rate may not
  reach 20
• First Wave????
• Awaiting results of RCT to decide on mode
• More publicity and endorsements of key
  medical/professional colleges and organisations
• More funding for incentives??

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Conclusions

• Potential to make a major contribution to
  understanding medical workforce dynamics
• Early days, and focusing on increasing the number
  who respond
• Relevance, trust and minimising their costs of
  completing the survey seem key