Evaluation of the Better Access initiative component C: analysis of the allied mental health workforce supply and distribution

2.2 Comparison of characteristics across occupational categories

Page last updated: September 2010

In this section, the focus is on the characteristics of the workforce as a whole. This snapshot of the workforce offers a different way of looking at the characteristics of the Better Access workforce by comparing them across occupational, or provider,19 categories.

In the following figures, the most current data has been used for age, gender, geographical distribution and use of MBS Items, namely the 2008 Medicare data. In these figures, the psychologist provider categories – clinical and registered – are differentiated. For the figures relating citizenship, the ABS 2006 Census has been used and the psychologist category has been combined.

2.2.1 Age
2.2.2 Gender
2.2.3 Country of birth and citizenship
2.2.4 Geographical distribution
2.2.5 Use of Better Access MBS items

2.2.1 Age

The most notable features of the age of the actual Better Access workforce is that it is older than the broader workforce (ABS Census) in these occupations (Table 2.17).

There is a higher than expected proportion of the actual Better Access workforce aged 50 and over and this is particularly so for psychiatrists and social workers. In both of these occupations more than 50% of the actual Better Access workforce is 50 years of age or over (Figure 2.1). This has significant implications for workforce planning.

Table 2.17 Proportion (%) of workforce 50 years and over, by occupation

ABS 2006 (%)MBS Actual 2008 (%)
General practitioners
39
47
Psychiatrists
43
57
Psychologists
34
42
Social workers
30
57
Occupational therapists
12
32

Sources: ABS. 2006 Census of Population and Housing
Medicare Australia. 2006-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data: Referring Provider Data

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Figure 2.1 Distribution of the age cohorts (%) of Better Access service providers, by occupation, 2008

Text equivalent of Figure 2.1 below. Distribution of the age cohorts (%) of Better Access service providers, by occupation, 2008

Source: Medicare Australia. 2006-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data: Servicing Provider Data

Text version of Figure 2.1

Figures in this description are approximate as they have been read from the graph.
15-29 years
(%)
30-39 years
(%)
40-49 years
(%)
50-59 years
(%)
60+ years
(%)
General practitioner
2
18
31
31
18
Psychiatrist
0
13
30
32
25
Clinical psychologist
5
30
25
27
13
Registered psychologist
7
25
25
28
15
Occupational therapist
16
30
22
23
9
Social worker
1
14
28
42
15
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2.2.2 Gender

The gender distribution of the actual Better Access workforce illustrates that the allied mental health workforce is female dominated, while the medical mental health workforce is male dominated (Figure 2.2). These patterns reflect the composition of the broader (ABS Census) Better Access workforce. For psychiatrists, however, service providers using Better Access were even more likely to be male in comparison with the broader psychiatric workforce: 60% male in 2006 ABS Census compared to 69% male in 2008 MBS data (see Table 2.16).

Figure 2.2 Distribution of gender (%) of Better Access service providers, by occupation, 2008

Text equivalent of Figure 2.2 below. Distribution of gender (%) of Better Access service providers, by occupation, 2008

Source: Medicare Australia. 2006-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data: Servicing Provider Data

Text version of Figure 2.2

Figures in this description are approximate as they have been read from the graph.
Male (%)Female (%)
General practitioner
60
40
Psychiatrist
69
31
Clinical psychologist
28
72
Registered psychologist
25
75
Occupational therapist
9
91
Social worker
19
81
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2.2.3 Country of birth and citizenship

As the data on the Better Access workforce did not use standard classifications for country of birth or citizenship, the 2006 ABS Census data is used here to provide a general overview. The figures in this section therefore depict characteristics of the broader (not actual) Better Access workforce. As Figure 2.3 illustrates, the medical mental health workforce has high proportions of overseas born workers and is likely to be reliant on these workers to meet demand. In the allied mental health occupations, approximately 24% of this workforce is born overseas.

Of the mental health workforce born overseas, a high proportion has Australian citizenship. In the allied mental health occupations, only 18% of foreign born health professionals within the potential Better Access workforce do not have Australian citizenship; this rises to around 28% for the medical mental health workforce (see Figure 2.4).

Figure 2.3 Frequency and distribution of Australian and foreign born workers (%), for each of the Better Access occupation categories, 2006

Text equivalent of Figure 2.3 below. Frequency and distribution of Australian and foreign born workers (%), for each of the Better Access occupation categories, 2006

Source: ABS. 2006 Census of Population and Housing

Text version of Figure 2.3

Figures in this description are approximate as they have been read from the graph.
Born in Australia (number)Born in Australia (%)Born in other countries (number)Born in other countries (%)
General medical practitioner
14,500
50
14,500
50
Psychiatrist
1,080
54
920
46
Psychologist
10,125
75
3,375
25
Occupational therapist
5,400
83
1,100
17
Social worker
9,175
74
3,225
26
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Figure 2.4 Frequency and distribution of the Australian citizenship status of foreign born workers (excl. Australian born) (%), for each of the Better Access occupation categories, 2006

Text equivalent of Figure 2.4 below. Frequency and distribution of the Australian citizenship status of foreign born workers (excl. Australian born) (%), for each of the Better Access occupation categories, 2006

Source: ABS. 2006 Census of Population and Housing

Text version of Figure 2.4

Figures in this description are approximate as they have been read from the graph.
Australian (number)Australian (%)Not Australian (number)Not Australian (%)
General medical practitioner
10,600
73
3,900
27
Psychiatrist
560
70
240
30
Psychologist
3,040
80
760
20
Occupational therapist
720
72
280
28
Social worker
2,450
79
650
21
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2.2.4 Geographical distribution

State / territory

The distribution of the actual Better Access workforce by state/territory highlights differences between jurisdictions in the use of Better Access. Except for social work (where Victoria has a higher proportion than expected), the proportion of service providers in each provider category in each state was similar to that of the potential Better Access workforce. This means that the differences in the proportions of service providers across occupations also reflect those in the broader workforce and are likely to be the result of policy and practices within those states.20

Some features are worth noting (Figure 2.5). In Victoria there is a comparatively lower proportion of GPs and clinical psychologists in the Better Access workforce and quite a large proportion of registered psychologists; in Queensland, clinical psychologists comprise a relatively small proportion of the Better Access workforce; in SA, there is a higher proportion of psychiatrists in the Better Access workforce, but a smaller proportion of registered psychologists; whereas in WA, there is a high proportion of clinical psychologists and relatively small proportion of psychiatrists in the Better Access workforce. Of the smaller states/territories, the ACT has a high proportion of registered psychologists and low proportion of GPs compared to the NT and Tasmania.

Figure 2.5 Distribution by state/territory (%) of Better Access service providers, by occupation, 2008

Text equivalent of Figure 2.5 below. Distribution by state/territory (%) of Better Access service providers, by occupation, 2008

Source: Medicare Australia. 2006-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data: Servicing Provider Data

Text version of Figure 2.5
Figures in this description are very approximate as they have been read from the graph.
General practitioner
(%)
Psychiatrist
(%)
Clinical psychologist
(%)
Registered psychologist
(%)
Occupational therapist
(%)
Social worker
(%)
NSW
64
4
7
22
1
2
VIC
59
5
6
26
1
3
QLD
68
4
4
21
1
2
SA
68
7
8
13.5
1.5
2
WA
65
4
12
15.5
1.5
2
TAS
74
4
7
11
1
2
NT
76
3
4
16
1
3
ACT
57
4
7
32
1.5
1.5
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Metropolitan, rural, remote

From the tables in Section 2.1 it was evident that the majority of service providers in all Better Access provider categories are located in capital cities and large metropolitan centres, as is the majority of the Australian population.

The Better Access workforce is not evenly distributed throughout regional, rural and remote areas. As the RRMA category increases in remoteness, the proportion of GPs in the Better Access workforce increases, ranging from around 60% in capital cities and other large metropolitan areas to 90% in other remote centres (Figure 2.6). Social workers maintain a small but relatively consistent proportion of the Better Access workforce across five of the RRMA categories; and there are a higher proportion of registered psychologists in other metropolitan areas and large rural centres than in capital cities and other large metropolitan areas. Of the remaining Better Access provider categories, psychiatrists and clinical psychologists are similar in their pattern of distribution, although there are a higher proportion of psychiatrists than clinical psychologists in other remote centres.

Figure 2.6 Distribution of Better Access service providers by RRMA geographic categories, by occupation, 2008

Text equivalent of Figure 2.6 below. Distribution of Better Access service providers by RRMA geographic categories, by occupation, 2008

Source: Medicare Australia. 2006-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data: Servicing Provider Data

Text version of Figure 2.6
Figures in this description are very approximate as they have been read from the graph.
General practitioner
(%)
Psychiatrist
(%)
Clinical psychologist
(%)
Registered psychologist
(%)
Occupational therapist
(%)
Social worker
(%)
Capital cities and large metro areas
61
7
9
20
1
2
Other metro centre
64
4
6
23
1.5
1.5
Large rural centre
67
4
4
21.5
1.5
2
Small rural centre
73
2
4.5
17.5
1
2
Other rural centre
80.5
2
2
13
0.5
2
Remote centre
82
3
3
11
0.5
0.5
Other remote centre
90
3
1.5
4.5
0.5
0.5
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2.2.5 Use of Better Access MBS items

For a summary of the number of Better Access services provided by occupation category and MBS Item number, 2006 to 2008, refer to Appendix B.

2.2.5.1 Frequency of use of Better Access items per occupation

The comparison across occupations of the frequency of use of Better Access Items, illustrated in Figure 2.7, shows that the GP and registered psychology provider categories have the highest levels of utilisation and that their use of Better Access is still increasing. In contrast, the level of service provision across the psychiatry provider category has been virtually the same for 2007 and 2008.21 Although providing the smallest number of Better Access services, the social work and occupational therapy provider categories still registered an increase in service provision from 2007 to 2008.

Figure 2.7 Frequency of service provision of Better Access MBS Items, per annum, by occupation, 2006 to 2008

Text equivalent of Figure 2.7 below. Frequency of service provision of Better Access MBS Items, per annum, by occupation, 2006 to 2008

Source: Medicare Australia. 2006-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data: Servicing Provider Data

Text version of Figure 2.7
Figures in this description are approximate as they have been read from the graph.
Number of services in 2006Number of services in 2007Number of services in 2008
General practitioner
96,512
1,013,013
1,364,736
Psychiatrist
14,118
94,116
101,304
Clinical psychologist
14,000
500,000
770,000
Registered psychologist
46,000
1,010,000
1,370,000
Occupational therapist
115
10,465
21,156
Social worker
1,512
5,282
102,714
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2.2.5.2 Average number of Better Access services per provider

When the frequency of service provision is broken down into the average number of services provided per provider in each provider category, the picture of use is quite different. As illustrated in Figure 2.8, health professionals in the allied mental health workforce have a far higher rate of services per provider than in the medical mental health workforce. The clinical psychologists that deliver services through Better Access do so at a considerably higher rate than other provider categories. In all of the allied health provider categories the average number of Better Access Items per service provider per annum has increased each year.

Figure 2.8 Average number of Better Access MBS items per service provider, per annum, by occupation category, 2006 to 2008

Text equivalent of Figure 2.8 below. Average number of Better Access MBS Items per service provider, per annum, by occupation category, 2006 to 2008

Source: Medicare Australia. 2006-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data: Servicing Provider Data

Text version of Figure 2.8
Figures in this description are approximate as they have been read from the graph.
Average Better Access MBS items
per service provider in 2006
Average Better Access MBS items
per service provider in 2007
Average Better Access MBS items
per service provider in 2008
General practitioner
8
51
64
Psychiatrist
13
62
63
Clinical psychologist
20
275
340
Registered psychologist
18
160
200
Occupational therapist
5
91
123
Social worker
12
108
159
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2.2.5.3 Average time providing Better Access services per provider

The allied mental health workforce use Better Access Items for a greater number of hours per week than the medical mental health workforce (see Figure 2.9). Clinical psychologists spend the most number of hours per week in the provision of Better Access services, followed by registered psychologists, social workers and occupational therapists. Of these, 80% of clinical psychologists deliver services through Better Access for more than 1 hour per week. In comparison, just over 30% of psychiatrists use Better Access for more than 1 hour per week.

Figure 2.9 Distribution of the hours worked per week (%) of Better Access service providers, by occupation, 2008

Text equivalent of Figure 2.9 below. Distribution of the hours worked per week (%) of Better Access service providers, by occupation, 2008

Source: Medicare Australia. 2006-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data: Servicing Provider Data

Text version of Figure 2.9
Figures in this description are approximate as they have been read from the graph.
<= 1 hour per week
(%)
1-2 hours per week
(%)
2-3 hours per week
(%)
3-5 hours per week
(%)
5-10 hours per week
(%)
> 10 hours per week (%)
General Practitioner
88
8
3
0.5
0.5
0
Consultant Psychiatrist
68.5
20
6
5
0.5
0
Clinical Psychologist
15
11
9
16
30
19
Registered Psychologist
28
13
10
15
22
12
Occupational Therapist
53
12
7
17
8
3
Social Worker
40
19
13
14
10
4

Footnotes

19 For all occupations except psychology, the occupational category is taken to be the same as the provider category in the Better Access workforce. For psychologists, the occupational category is psychology, but this includes two provider categories: registered psychologist and clinical psychologist.
20 If the distribution of service providers was based on some other criteria, for example, population, then the proportions for each state would be the same for each occupation: Victoria has nearly 25% of Australia's population, so a proportional distribution of service providers would mean that 25% of each occupation would be in Victoria.
21 Better Access Items represent a relatively small proportion of MBS-subsidised services provided by psychiatrists.