Palliative care workforce

Workforce planning is an essential element in achieving functional and sustainable healthcare across the palliative care sector (DoH 2019). A key challenge faced by the palliative care sector is the increasing demand for services due to an aging population and growing prevalence of chronic diseases, which places greater pressure on the palliative care workforce. As such, understanding the size, demographics and distribution of the palliative care workforce is key to meeting ongoing demand for palliative care in Australia.

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The information in this section was last updated in October 2021.

Key points

  • There were 273 full-time equivalent palliative medicine physicians (1.1 per 100,000 population) and 3,157 palliative care nurses (12.4 per 100,000 population).

  • Females accounted for 2 in 3 (64%) employed palliative medicine physicians and 9 in 10 (93%) palliative care nurses.

  • The vast majority of the palliative care workforce worked in Major cities – 9 in 10 (87%) employed palliative medicine physicians and 3 in 4 (72%) employed palliative care nurses.

  • 3 in 4 (76%) employed palliative medicine physicians worked in a hospital setting, compared with about half (52%) of employed palliative care nurses.

Between 2014 and 2019:

  • There was a 50% increase in the number of employed palliative medicine physicians (from 195 to 292 physicians) and a 10% increase in the number of palliative care nurses (from 3,312 to 3,658 nurses).

The palliative care workforce consists of a number of health professional groups including specialist palliative medicine physicians, nurses, nurse practitioners, general practitioners, pharmacists, other medical specialists (such as oncologists and geriatricians), as well as other health workers, support staff and volunteers (see Box WK.1).

The information presented in this section describes the number and characteristics of the employed workforce of physicians with a primary specialty of palliative medicine (referred to as ‘palliative medicine physicians’) and nurses working in palliative care (referred to as ‘palliative care nurses’). Information on other professions who may provide palliative care, such as those noted above, is not presented due to a lack of comprehensive data.

The information on palliative medicine physicians and palliative care nurses presented in this section was derived from the National Health Workforce Data Set (NHWDS) for the period 2014 to 2019. Further details on the NHWDS are outlined in Data Sources section.

Box WK.1 Physicians and nurses specialising in palliative care

Both doctors and nurses usually complete specialised training in addition to their medical/nursing degrees to work in palliative care.

Medical specialists must have completed post-graduate specialist training to become a palliative medicine physician. Palliative medicine physicians are required to have completed 3 years of full-time equivalent training in either a paediatric or adult setting under the supervision of a palliative medicine physician. Successful trainees gain the qualification of Fellow of the Royal Australasian College of Physicians (FRACP) / Fellowship of the Australasian Chapter of Palliative Medicine (FAChPM) and are accredited to practise as a palliative medicine physician in Australia or New Zealand. Medical practitioners may also complete a 6-month Clinical Diploma in Palliative Medicine, but this qualification does not result in specialist accreditation (RACP 2020).

The classification of nurses in Australia varies with the type of training they have undertaken and their scope of practice. Enrolled nurses have completed a 2-year Diploma of Nursing and work under the supervision of a registered nurse. Registered nurses have completed a 3-year Bachelor of Nursing, and have a broader scope of practice that may include assessing patients and developing a nursing care plan, supervising enrolled nurses and junior registered nurses, providing specialised nursing care and performing leadership roles such as nursing unit manager (DoH 2021). Nurse practitioners are registered nurses who have completed masters-level education and are endorsed by the Nursing and Midwifery Board to practice autonomously in an advanced and extended clinical role to diagnose, plan and deliver high quality comprehensive health care (NMBA 2016).

Nurse practitioners, registered nurses and enrolled nurses may complete a variety of short or more comprehensive courses (including postgraduate certificate and Masters qualifications) if they wish to work in the field of palliative care, and postgraduate qualifications are generally required for nurses working in specialist palliative care services (Centre for Palliative Care 2021).

Palliative medicine physicians

In 2019, there were 292 palliative medicine physicians employed in Australia, which accounted for 1 in 127 (0.8%) of all employed medical specialists.

The standard full-time working week (1 full-time equivalent, FTE) for medical practitioners is defined as 40 hours (38 hours for all other professions, including nurses; AIHW 2017). In 2019, there were 273 FTE (1.1 per 100,000 population) palliative medicine physicians, which included 213 clinical FTE physicians (see Table WK.1).

In addition, there were 6 paediatric palliative care physicians in Australia in 2019 (MBA 2020). These paediatric physicians are not included in the numbers presented here.

Age and sex

In 2019, almost 2 in 3 (64%) employed palliative medicine physicians were female, which was almost twice as high as for all medical specialists (34%).

Female palliative medicine physicians were younger than male physicians, with around 3 in 4 (77%) female physicians aged under 55, compared with 3 in 5 (59%) male physicians. For both male and female palliative medicine physicians, the 35–44 age group accounted for the highest proportion of palliative care physicians, accounting for 29% and 42% of male and female physicians respectively. In this age group, there were more than twice as many female palliative medicine physicians than males (78 female physicians compared to 31 male physicians; see Table WK.1).

Hours worked

In 2019, palliative medicine physicians worked on average 37.4 total hours per week, which was less than the average weekly hours for all employed medical specialists (42.5 hours). The average clinical hours worked per week (29.1 hours) was also less than for all employed specialists (35.4 hours).

Female palliative medicine physicians worked less hours on average per week than males (35.4 compared with 40.8 total hours per week; see Table WK.2).

Average total hours worked varied by jurisdiction, ranging from 34.3 hours per week in Victoria to 41.0 hours per week in Queensland (see Table WK.3).

Nationally, there were 1.1 FTE (0.8 clinical FTE) palliative medicine physicians per 100,000 population in 2019. The rate of FTE palliative medicine physicians per 100,000 population ranged from 0.9 in Victoria and South Australia to 1.3 in the Australian Capital Territory (Figure WK.1).

In 2019, nearly 9 in 10 (87%) employed palliative medicine physicians worked mainly in Major cities (255 physicians, compared with 36 physicians in Inner and Outer regional areas combined).

Taking into account differences in population sizes across remoteness areas, the FTE per 100,000 population for palliative medicine physicians was 1.3 in Major cities compared with 0.5 and 0.6 in Inner and Outer regional areas respectively (see Table WK.4).

Principal role and work setting

Of the 292 employed palliative medicine physicians in 2019, 269 (92%) were principally employed as clinicians, while the remainder were principally employed as administrators, teachers or educators, and researchers (see Table WK.5).

Around 3 in 4 (76% or 222) palliative medicine physicians were employed in a hospital setting, followed by 24 (8.2%) in outpatient services, 21 (7.2%) in other community health care services, and 14 (4.8%) in private practices (see Table WK.6).

Figure WK.1: Employed palliative medicine physicians, FTE and clinical FTE per 100,000 population, by states and territories, 2019

Australian map chart showing the rate per 100,000 population of Full Time Equivalent (FTE) and clinical FTE employed palliative medicine physicians in Australia by state and territory. New South Wales FTE 1.2, clinical FTE 1.0; Victoria FTE 0.9, clinical FTE 0.7; Queensland FTE 1.0, clinical FTE 0.9; Western Australia FTE 1.1, clinical FTE 0.9; South Australia FTE 0.9, clinical FTE 0.7; Tasmania FTE 1.1, clinical FTE 0.9; Australian Capital Territory FTE 1.3, clinical FTE 0.9; Northern Territory FTE n.p., clinical FTE n.p.; Total FTE 1.1, clinical FTE 0.8. Refer to Table Wk.3.

Source data: Palliative care workforce Table Wk.3 

Trends

Between 2014 and 2019, there was an overall increase of 50% in the number of employed palliative medicine physicians (from 195 in 2014 to 292 in 2019). This was a steeper increase than that observed for all specialist physicians (22% increase over the same period). Females accounted for 68% of the increase in palliative medicine physicians over this period (an increase from 120 to 186 female physicians, compared with 75 to 106 for males).

An increase in female palliative medicine physicians in all age groups was observed over the 6-year period, ranging from a 13% increase among those aged 65 years and over, to a 74% increase to those aged less than 45 years. The number of male palliative medicine physicians aged under 55 almost doubled in this time (from 34 to 63), with the largest increase (138%) in those aged 35–44 years (from 13 to 31; see Table WK.1).

For population rates of full-time employed palliative medicine physicians over time, there has been an increase from 0.8 FTE (0.6 clinical FTE) per 100,000 population in 2014 to 1.1 FTE (0.8 clinical FTE) in 2019 (see Table WK.1).

Palliative care nurses

In 2019, there were 3,658 palliative care nurses employed in Australia, 1.1% or 1 in 94 of all employed nurses. Over 4 in 5 (84%) palliative care nurses were registered nurses, while 1 in 6 (16%) were enrolled nurses (see Box WK.1). 

In addition, according to reporting by the Department of Health, there were 72 palliative care nurse practitioners in 2019. It is important to note that the health workforce surveys that these data are based on does not currently collect information on whether a nurse is employed in a job in which a nurse practitioner endorsement is required or utilised. Therefore, the data presented in this report cannot be disaggregated by nurse practitioner. This is expected to be included in the 2020 health workforce data (DoH 2020).

Age, sex, and Indigenous status

In 2019, over 9 in 10 (93%) employed palliative care nurses were female, which is slightly higher than the proportion of females among all nurses (89%).

Female palliative care nurses tended to be older than male nurses, with 62% of female nurses aged 45 and over, compared with 51% of male nurses aged 45 and over. In contrast, a higher proportion of male nurses were aged under 35 (28% compared to 19% for female nurses; see Table WK.7).

About 1 in 90 (1.1%) of employed palliative care nurses identified as Aboriginal and/or Torres Strait Islander, a relatively similar proportion to all nurses (1.4%; see Table WK.7).

Hours worked

In 2019, palliative care nurses worked an average of 32.8 hours per week, which was less than the total hours worked by all employed nurses (33.5 hours). In contrast, palliative care nurses worked slightly more clinical hours compared to all employed nurses (30.4 and 29.8 hours respectively).

Hours worked were, on average, lower for females than males (32.6 hours and 35.4 hours, respectively; see Table WK.8).

Average hours worked varied across jurisdictions, ranging from 30.7 hours per week in Western Australia, to 36.9 hours per week in the Northern Territory (see Table WK.9).

The standard full-time working week (1 full-time equivalent, FTE) for nurses is defined as 38 hours (AIHW 2017). Nationally, there were 12.4 FTE (11.5 clinical FTE) palliative care nurses per 100,000 population in 2019. The rate of FTE palliative care nurses per 100,000 population ranged from 11.9 in Queensland and Western Australia to 16.4 in Tasmania (Figure WK.2).

In 2019, almost 3 in 4 (72%) employed palliative care nurses worked mainly in Major cities, and around 1 in 5 (21%) worked in Inner regional areas.

Taking into account differences in population sizes for each remoteness area, the FTE per 100,000 population for palliative care nurses was highest for Inner regional areas (14.2 FTE), followed by Major cities (12.4 FTE), Outer Regional areas (10.9 FTE) and Remote areas (8.0 FTE) (see Table WK.10).

Principal role and work setting

Of the 3,658 employed palliative care nurses in 2019, nearly all (3,493 or 95%) were principally employed as clinicians (see Table WK.11).

Over half (1,913 or 52%) of all employed palliative care nurses were employed in a hospital setting, followed by 1 in 4 (963 or 26%) in community healthcare services and 1 in 8 (440 or 12%) in hospices (see Table WK.12).

Figure WK.2: Employed palliative care nurses, FTE and clinical FTE per 100,000 population, by states and territories, 2019

Australia map chart showing the rate per 100,000 population of Full Time Equivalent (FTE) and clinical FTE employed palliative care nurses working in Australia by state and territory. New South Wales FTE 12.2, clinical FTE 11.2; Victoria FTE 12.9, clinical FTE 11.9; Queensland FTE 11.9, clinical FTE 11.1; Western Australia FTE 11.9, clinical FTE 11.1; South Australia FTE 12.3, clinical FTE 11.5; Tasmania FTE 16.4, clinical FTE 15.2; Australian Capital Territory FTE 14.3, clinical FTE 13.4; Northern Territory FTE 15.0, clinical FTE 14.9; Total FTE 12.4, clinical FTE 11.5. Refer to Table Wk.9.

Source data: Palliative care workforce Table Wk.9 

Trends

Between 2014 and 2019, there was a 10% increase in the number of employed palliative care nurses, from 3,312 in 2014 to 3,658 in 2019. Over this period, there was a steeper increase in registered nurses than enrolled nurses (11% compared with 5% increase, respectively). The largest increases were seen in palliative care nurses aged less than 35 (47% increase for males and 32% increase for females) and females aged over 65 (53% increase). The number of nurses aged 45–54 decreased in both men and women (4.3% and 8.1% decrease respectively).

The population rate of FTE palliative care nurses has increased slightly over this period, from 12.1 FTE (11.1 clinical FTE) in 2014 to 12.4 FTE (11.5 clinical FTE) per 100,000 population in 2019 (see Table WK.7).