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

3.2 Distribution of the allied mental health workforce registered with Medicare, 2004-2008

Page last updated: September 2010

This section examines the trends or breaks in supply of each category in the private (Medicare)26 allied mental health workforce before and after the implementation of the Better Access in November 2006. It analyses the geographic distributions of psychologists, social workers and occupational therapists in the Medicare sector, distinguishing by state, and by region (urban, rural).

3.2.1 Psychology
3.2.2 Social work
3.2.3 Occupational therapy

3.2.1 Psychology

The psychology workforce is the largest component of the Better Access allied mental health workforce in the private (Medicare) sector. Before the implementation of Better Access, psychology mental health services were reported under MBS Item 10968. Better Access added another 10 MBS Items for which psychologists could provide services.

As indicated in previous sections of this report, the implementation of Better Access resulted in a significant increase in the number of psychologists registered with Medicare. The historical use of Medicare Items by psychologists is shown in Figure 3.33 for the period July 2004 to December 2008. This gives a graphic illustration of the spike in the numbers of psychologists upon the introduction of Better Access: increasing from 1,429 persons in October 2006 to 3,132 persons in November 2006.

The extent to which Better Access has impacted on the supply of psychologists into the private (Medicare) sector is also reflected by the changing average growth rate of the number of psychologists per month. During period October 2004 to October 2006 (i.e. prior to the Better Access) the average monthly growth rate of the actual numbers of psychologists was 2.4%, and the growth was on a small base. Since the implementation of Better Access in November 2006 the average monthly growth rate of this workforce was 3.4%, and the growth was on a relatively large base.

The increase in the supply of psychologists into the private (Medicare) sector is evident across all states and territories (Figure 3.34). The biggest impact of Better Access on the psychology workforce occurred in four states – NT, ACT, SA, and WA – each of which grew 8-12 times by December 2008 from the October 2006 levels. NSW has had the largest segment of the psychology workforce both before and after the implementation of the Better Access, however, its share slid by about 8 percentage points, dropping from 40% prior to the Better Access to 35.1% in November 2006 and further to 32.1% in November 2008 (Table 3.2). In contrast, WA almost doubled its share from 5% prior to the Better Access to 9.4% in November 2008. Similarly, SA doubled its share from 3% to 6% on the same time horizon.

Better Access increased the supply of psychologists providing mental health services using MBS Items in both urban and rural areas (Figure 3.35). In the urban areas (capital cities and metropolitan areas), the psychology workforce increased by about four fold in a short period following the implementation of Better Access; in the rural areas in this workforce increased by 3.6 times during the same period. The psychology workforce is disproportionately distributed between the urban areas and rural areas (Table 3.1). Psychologists in the urban areas have consistently accounted for about 80% of this workforce. There was a slight reduction of the share of this workforce that provided Better Access services to people residing in rural centres after the implementation of the Better Access.
Top of page

Figure 3.33 Change in total numbers of psychologists in the private (Medicare) workforce, 2004-2008

Text equivalent of Figure 3.33 below.  Change in total numbers of psychologists in the private (Medicare) workforce, 2004-2008

Source: Medicare Australia. 2004-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data

Text version of Figure 3.33

Figures in this description are approximate as they have been read from the graph.

The total number of psychologists in the private (Medicare) workforce rose steadily from about 0 in July 2004 to about 1,200 in November 2006. The total number then grew sharply to about 4,500 in March 2007.

From March 2007, total numbers steadily increased to about 7,000 in September 2008.

Figure 3.34 Change in total numbers of psychologists in the private (Medicare) workforce: 2004-2008, by state/territory

Text equivalent of Figure 3.34 below.  Change in total numbers of psychologists in the private (Medicare) workforce: 2004-2008, by state/territory

Source: Medicare Australia. 2004-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data

Top of page

Text version of Figure 3.34

Figures in this description are approximate as they have been read from the graph.

In New South Wales, the total number of psychologists in the private (Medicare) workforce rose steadily from about 0 in July 2004 to about 550 in November 2006. The number of psychologists then grew sharply to about 1,700 in March 2007. From March 2007, total numbers steadily increased to about 2,250 in September 2008.

In Victoria, the total number of psychologists rose steadily from about 0 in July 2004 to about 500 in November 2006. The number of psychologists then grew sharply to about 1,700 in March 2007. From March 2007, total numbers steadily increased to about 2,250 in September 2008.

In Queensland, the total number of psychologists rose steadily from about 0 in July 2004 to about 250 in November 2006. The number of psychologists then grew sharply to about 750 in March 2007. From March 2007, total numbers steadily increased to about 1,200 in September 2008.

In South Australia, the total number of psychologists slowly rose from about 0 in July 2004 to about 50 in November 2006. The number of psychologists then grew sharply from about 50 in November 2006 to about 250 in March 2007. From March 2007, total numbers steadily increased to about 450 in September 2008.

In Western Australia, the total number of psychologists slowly rose from about 0 in July 2004 to about 50 in November 2006. The number of psychologists then grew sharply from about 50 in November 2006 to about 450 in March 2007. From March 2007, total numbers steadily increased to about 660 in September 2008.

In Tasmania, the total number of psychologists slowly rose from about 0 in July 2004 to about 100 in September 2008.

In the ACT, the total number of psychologists slowly rose from about 0 in July 2004 to about 100 in September 2008.

In the Northern Territory, the total number of psychologists slowly rose from about 0 in July 2004 to about 10 in November 2006.

Figure 3.35 Change in numbers of psychologists in the Medicare workforce 2004-2008, by region (urban, rural)

Text equivalent of Figure 3.35 below.  Change in numbers of psychologists in the Medicare workforce 2004-2008, by region (urban, rural)

Source: Medicare Australia. 2004-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data

Top of page

Text version of Figure 3.35

Figures in this description are approximate as they have been read from the graph.

In urban areas, the total number of psychologists in the Medicare workforce gradually grew, with a few minor fluctuations, from about 0 in July 2004 to about 1,100 in November 2006. There was a sharp increase from about 1,100 in November 2006 to about 4,000 in March 2007. Numbers then steadily grew from about 4,000 in March 2007 to about 5,500 in September 2008.

In rural areas, the total number of psychologists in the Medicare workforce gradually grew from about 0 in July 2004 to about 200 in November 2006. There was a sharp increase from about 200 in November to about 900 in March 2007. Numbers then very gradually increased from about 900 in March 2007 to about 1,300 in September 2008.

Table 3.1 Change in proportion (%) of psychology workforce in the private (Medicare) sector 2004-2008, by state/territory, by region

Total headcountsNSW
(%)
VIC
(%)
QLD
(%)
SA
(%)
WA
(%)
TAS
(%)
ACT
(%)
NT
(%)
Urban Region
(%)
Rural Region
(%)
Oct-04
440
41.1
33.0
15.9
2.7
4.8
1.8
0.7
0.0
82.3
17.7
Oct-05
858
41.1
29.6
17.9
3.1
5.0
1.7
1.4
0.0
77.3
22.6
Oct-06
1429
40.9
33.2
15.1
3.0
4.6
1.9
1.0
0.2
79.9
20.1
Nov-06
3138
35.1
33.4
15.5
4.5
7.0
2.0
2.2
0.3
81.8
18.2
Nov-07
6114
32.5
31.9
15.8
6.1
8.9
1.9
2.4
0.5
81.0
18.9
Nov-08
7054
32.1
31.5
16.2
6.0
9.4
1.8
2.5
0.5
80.7
19.1

Source: Medicare Australia. 2004-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data


Registered and clinical psychology provider categories

This section provides a more detailed understanding of change in the supply of psychologists using MBS Items by differentiating between registered and clinical psychologists after the implementation of Better Access. As discussed in Section 2.1.1, some clinical psychologists provide both Focussed Psychological Strategies and Psychological Therapy Services, resulting in an exaggeration of the numbers of psychologists: that is, the number of clinical plus registered psychologists providing Better Access services is greater than the total number of Better Access psychologists. In the following analysis, MBS Item 10968 has been excluded from the estimation as it cannot be split between the two categories.

The supply of both clinical and registered psychologists into the Medicare sector has increased since the implementation of Better Access (Figure 3.36). The number of registered psychologists using MBS Items has doubled since the implementation of Better Access. Registered psychologists remain the dominant group in their use of MBS Items, accounting for between 82.5% of psychology service providers in November 2006 and 70.2% in November 2008. However, the dominance of registered psychologists has been reduced owing to the faster growing proportion of clinical psychologists using MBS Items, which went from 17.5% to about 30% over the same period. Although clinical psychology has been a smaller provider category than that of registered psychology, it has maintained a fast growing trend since November 2006, and increased by 3.2 times by November 2008.

The differential increase in these two provider categories is also well reflected in their average monthly growth rates, distinguishing by state, and by region (Table 3.2). The average growth rate of the total registered psychologists in the private sector was 3.1% per month over the 24-month period to December 2008. The average growth rate of clinical psychologists registered with Medicare grew to 6.2% per month over the 24-month period to November 2008. All states/territories except NT, Vic and WA experienced higher growth than the average over the same period. There is a different growth pattern between the urban and rural areas for these two psychology categories. For registered psychologists, their numbers increased at a slightly higher growth rate (3.4% per month), from a much smaller base, in rural areas than in urban areas (3.1%). In contrast, clinical psychologists increased in number at a higher rate (6.2% per month), and on a larger base, in the urban areas than in rural areas (5.9%).
Top of page
The distribution of the clinical and registered psychology Medicare provider categories has been analysed using proportions. The distribution of registered psychologists across all states/territories is measured as the percentage of Medicare registered psychologists in a particular state relative to the total number (headcounts) of this workforce in the Medicare sector. As Table 3.3 illustrates, the share of registered psychologists has been relatively constant during the 25 months since implementing Better Access. Victoria and NSW together comprise two thirds of the registered psychology workforce. It is noted that the share of NSW declined by 4 percentage points from 35.9% in November 2006 to 31.5% in November 2008.

The pattern for the clinical psychology provider category has slightly more variation, especially in NSW and Victoria (Table 3.4). The proportion of clinical psychologists in NSW climbed from 30% in November 2006 to 33% by February 2007, overtaking Victoria. Since then, NSW has consistently had the largest proportion of this provider category. In contrast, the proportion in Victoria dropped by 8 percentage points over a 2-year period (from 32% in November 2006 to 24% in November 2008), with WA dropping moderately from 20% in December 2006 to 17.3% by February 2008. Surprisingly, the proportion of clinical psychologists in SA nearly doubled after one year following the implementation of Better Access, increasing from 5.1% in November 2006 to 9.1% in January 2008 where it has stayed. For the remaining states, their share of the clinical psychology provider category has remained virtually unchanged.

Both categories of psychologists are predominantly distributed in urban areas (Table 3.4). Of the registered psychologists providing Better Access services, about 82% work in the urban areas, while 18% work in rural areas. The concentration of clinical psychologists providing Better Access services is even greater than that of registered psychologists. About 90% of clinical psychologists work in the urban areas, with a small proportion (10%) of them providing services in rural areas.

Figure 3.36 Change in numbers of registered and clinical psychologists in the Better Access workforce since November 2006

Text equivalent of Figure 3.36 below.  Change in numbers of registered and clinical psychologists in the Better Access workforce since November 2006

Source: Medicare Australia. 2004-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data

Text version of Figure 3.36
Figures in this description are approximate as they have been read from the graph.

The number of registered psychologists in the Better Access workforce steadily grew from about 2,300 in November 2006 to about 3,600 March 2007. The growth in numbers then slowed slightly, gradually growing from about 3,600 in March 2007 to about 4,900 in November 2008. During this period there was a drop in total number of registered psychologists of about 300 over the period of November 2007 to January 2008.

The number of clinical psychologists gradually grew from about 500 in November 2006 to about 2,000 in November 2008.
Top of page

Table 3.2 Growth in numbers and average growth rates (%) of psychologists in the private (Better Access) workforce 2006-2008, by category, by state, by region

TotalNSWVICQLDSAWATASNTACTUrban RegionRural Region
Registered psychologists in Nov 2006
2,337
838
791
394
102
109
45
6
52
1,932
405
Registered psychologists in Nov 2008
4,916
1,548
1,709
901
233
296
70
31
128
4,012
904
Registered psychologists: % average growth rate per month, Nov 2006 - Nov 2008
3.1
2.6
3.3
3.5
3.5
4.3
1.9
7.1
3.8
3.1
3.4
Clinical psychologists in Nov 2006
494
147
159
46
25
93
14
3
7
443
51
Clinical psychologists in Nov 2008
2,084
693
505
226
190
361
57
7
45
1,881
203
Clinical psychologists: % average growth rate per month: Nov 2006 - Nov 2008
6.2
6.7
4.9
6.9
8.8
5.8
6.0
3.6
8.1
6.2
5.9

Source: Medicare Australia. 2004-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data

Table 3.3 Change in proportion of registered and clinical psychologists in the private (Better Access) workforce, by state, by region

NSW (%)VIC (%)QLD (%)SA (%)WA (%)TAS (%)NT (%)ACT (%)Urban Region (%)Rural Region (%)
Registered psychologists in Nov 2006
35.9
33.8
16.9
4.4
4.7
1.9
0.3
2.2
82.7
17.3
Registered psychologists in Nov 2007
32.0
34.5
18.0
5.3
5.7
1.6
0.5
2.4
82.0
18.0
Registered psychologists in Nov 2008
31.5
34.8
18.3
4.7
6.0
1.4
0.6
2.6
81.6
18.4
Clinical psychologists in Nov 2006
29.8
32.2
9.3
5.1
18.8
2.8
0.6
1.4
89.7
10.3
Clinical psychologists in Nov 2007
33.5
25.4
9.7
8.3
17.7
2.7
0.4
2.2
90.9
9.1
Clinical psychologists in Nov 2008
33.3
24.2
10.8
9.1
17.3
2.7
0.3
2.2
90.3
9.7

Source: Medicare Australia. 2004-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data

3.2.2 Social work

Social workers could only register with Medicare after the implementation of the Better Access initiative. As shown in Figure 3.37, this workforce has been steadily growing over the two year period, with the exception of a small reduction in January 2008.

Increases in numbers of social workers using Better Access are greater in NSW and Victoria and in the capital cities and other metropolitan areas, compared to other states or rural areas (Table 3.4). Major changes in the proportional distribution of the social work workforce occurred in two states (NSW, Victoria). The proportion of the social work workforce in Victoria increased from 28% (in November 2006) to 38.4% (in November 2008). In contrast, the proportion in NSW decreased from 45% to 29.1% over the same period. The proportions in the states of Qld, SA and WA remained almost unchanged.

More than three quarters of the social workers in the private sector are distributed in the urban areas, while the remaining services in rural areas (Table 3.4). The pattern of distribution of social workers registered with Medicare between the urban and rural areas were quite stable over the two-year period of implementing the Better Access initiative.
Top of page

Figure 3.37 Change in total numbers of social workers using Better Access, 2006-2008

Text equivalent of Figure 3.37 below.  Change in total numbers of social workers using Better Access, 2006-2008

Source: Medicare Australia. 2004-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data

Text version of Figure 3.37

Figures in this description are approximate as they have been read from the graph.

The total number of social workers using Better Access has steadily increased from about 100 in November 2006 to about 550 in November 2008. During this period there was a slight drop of about 30 betweeen November 2007 and January 2008.

Table 3.4 Change in proportion (%) of social workers in the private (Medicare) workforce 2006-2008, by state/territory, by region

Total headcountsNSW (%)VIC (%)QLD (%)SA (%)WA (%) TAS (%)NT (%)ACT (%)Urban Region (%)Rural Region (%)
Nov 06
100
45.0
28.0
14.0
6.0
7.0
0.0
0.0
0.0
78.0
22.0
Nov 07
430
30.2
35.8
16.7
6.3
7.7
2.3
0.5
0.5
78.6
21.4
Nov 08
557
29.1
38.4
15.3
6.5
7.4
2.3
0.4
0..9
78.3
21.3

Source: Medicare Australia. 2004-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data

3.2.3 Occupational therapy

Before November 2006, Medicare services provided by occupational therapists (OTs) were reported under Item 10958, which was still in use as at December 2008. Since November 2006, five new MBS Items have been introduced as part of Better Access. The OT workforce registered with Medicare is fairly small: having just five persons in July 2004. This number increased to 209 persons by October 2006, just prior to the commencement of Better Access (Figure 3.38a). By November 2008 this workforce totalled 457 persons - this includes OTs providing Better Access services and those providing services under MBS Item 10958. There is considerable variation in the supply of OTs providing MBS services across states/territories and between regions (Figure 3.38b, Figure 3.38c). In December 2008, for example, there was a difference of 174.7% between the state with the lowest and the state with the highest numbers in the private (Medicare) OT workforce.

The extent to which Better Access has impacted on the supply of OTs into Medicare sector was indicated by change in the proportion of this workforce among states/territories and between regions (Table 3.5). OTs have disproportionately provided Better Access mental health services to people in the four large states: NSW, Victoria, Queensland and WA.
Top of page
Yet the degree of concentration of this workforce decreased slightly from an overall proportion 96% prior to implementing the Better Access initiative to 93% right after implementing the Better Access. There was variation in the OT workforce among these four states. For instance, the proportions for NSW and WA presented a downward trend, while they did not vary much in Victoria and Queensland.

Approximately 80% of the OT workforce registered with Medicare provided MBS services to people residing in capital cities and other metropolitan areas. This distributional concentration of OTs in the urban areas is consistent with the national population distribution. The Better Access initiative has significantly stimulated the supply of this workforce in both urban and regional areas, but there has been no apparent trend of change in the workforce distribution between the two broad geographical regions.

Figure 3.38a. Change in total numbers of occupational therapists 2004-2008

Text equivalent of Figure 3.38a below.  Change in total numbers of occupational therapists 2004-2008

Source: Medicare Australia. 2004-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data

Text version of Figure 3.38a

Figures in this description are approximate as they have been read from the graph.

The total number of occupational therapists rose in a fluctuating manner from about 0 in July 2004 to about 400 in November 2008.
Top of page

Figure 3.38b. Change in total numbers of occupational therapists 2004-2008, by state/territory


Text equivalent of Figure 3.38b below.  Change in total numbers of occupational therapists 2004-2008, by state/territory

Source: Medicare Australia. 2004-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data

Text version of Figure 3.38b

Figures in this description are approximate as they have been read from the graph.

In all states and territories, the total numbers of occupational therapists have risen in a fluctuating manner:
  • NSW - from about 0 in July 2004 to about 140 in November 2008.
  • VIC - from about 0 in July 2004 to about 112 in November 2008.
  • QLD - from about 0 in July 2004 to about 60 in November 2008.
  • SA - from about 0 in July 2004 to about 19 in November 2008.
  • WA - from about 0 in July 2004 to about 45 in November 2008.
  • TAS - from about 0 in July 2004 to about 5 in November 2008.
  • NT - from about 0 in July 2004 to about 2 in November 2008.
  • ACT - from about 0 in July 2004 to about 5 in November 2008.
Top of page

Figure 3.38c. Change in total numbers of occupational therapists 2004-2008, by region


Text equivalent of Figure 3.38c below.  Change in total numbers of occupational therapists 2004-2008, by region

Source: Medicare Australia. 2004-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data

Text version of Figure 3.38c

Figures in this description are approximate as they have been read from the graph.

In both urban and rural areas, the total numbers of occupational therapists have risen in a fluctuating manner:
  • Urban areas - from about 0 in July 2004 to about 310 in November 2008.
  • Rural areas - from about 0 in July 2004 to about 80 in November 2008.

Table 3.5 Change in proportion of occupational therapists in the private (Medicare) workforce, 2004-2008, by state/territory, by region

Total headcountsNSW (%)VIC (%)QLD (%)SA (%)WA (%) TAS (%)NT (%)ACT (%)Urban Region (%)Rural Region (%)
Nov 04
64
25.0
25.0
29.7
4.7
15.6
0.0
0.0
0.0
76.6
23.4
Nov 05
126
40.5
25.4
20.6
3.2
9.5
0.0
0.0
0.8
81.0
19.0
Nov 06
223
37.7
26.0
17.5
3.1
14.8
0.0
0.4
0.4
79.8
21.1
Nov 07
355
35.5
24.5
20.8
4.8
12.7
0.6
0.3
1.1
76.6
24.8
Nov 08
457
33.9
27.8
19.5
4.6
12.0
0.9
0.2
1.3
79.0
21.9

Source: Medicare Australia. 2004-08 Medicare Provider Data and Medicare Benefit Schedule (MBS) data

Footnotes

26 The term private (Medicare) workforce refers to service providers who have used MBS Items which include, but go beyond those associated with Better Access.