Context: Demand for specialist palliative care is increasing due to population ageing and rising mortality, yet growth in the specialist workforce remains constrained.
Objectives: To project specialist palliative care workforce capacity in Australia and estimate resulting workforce-constrained unmet need for palliative care.
Methods: We developed a national palliative care service planning model to project workforce supply (physicians and nurses) from 2025 to 2045 using empirically estimated flows by age, sex, geography, and profession. Required workforce capacity was estimated using nationally endorsed staffing benchmarks indexed to projected mortality. Unmet need was defined as the gap between required and available capacity, expressed as the number of decedents unable to access minimum recommended levels of specialist palliative care.
Results: Although the palliative care physician workforce is projected to grow at 3.1% (95% CI: 2.4-3.7%) annually, this is insufficient to match increasing mortality-driven demand. By 2045, an estimated 106,470 decedents (95% CI: 82,402–129,736) each year will be unable to access recommended levels of specialist palliative care, over 38,500 more than at present. Cumulatively, almost 1.7 million Australians are projected to experience unmet need for palliative care between 2025 and 2045. Geographic inequities are substantial, with outer regional areas accounting for 15% of unmet need despite comprising 8% of the population. Growth in the nursing workforce is modest and does not offset rising demand.
Conclusion: Under current trajectories, specialist palliative care capacity in Australia is unlikely to keep pace with population need, leading to substantial and widening gaps in access. These findings suggest that unmet need is a structural feature of the system rather than a transient shortfall. Addressing this gap will require expansion of the workforce, changes in service delivery, including greater integration of generalist practitioners, timing of palliative care delivery, and more flexible, system-level approaches to care.