Since I became NASOG President in 2019, I have used the word ‘Crisis’ in relation to obstetric services in almost every article, interview and meeting I have been involved in.
This is not an overstatement and far from being sensationalist, the situation is worsening and demands our attention if we are to safeguard obstetric services into the future.
The current recruitment and retention difficulties we are currently seeing, particularly in regional Australia are every bit as dire as the previous indemnity crisis that saw the viability of our specialty seriously questioned.
As 2023 unfolds, it is clear that the delays in action on the issues around maternity services generally have become just as serious as predicted by NASOG, if not more so.
In late 2019, the previous Federal Government started some work through the Department of Health on the ‘Future of Private Obstetrics’. This project was prompted by the significant drop in patients using private obstetric care, the increase (at the time) in fixed price private birthing models, and the assumption that public hospitals would be unable to cope if private obstetrics continued to fall.
Unfortunately, the project fell by the wayside due to the public health emergency of the COVID-19 Pandemic.
Which meant that over the past 3 years, the situation in obstetrics has quietly continued to worsen.
NASOG’s own review of the publicly available data on MBS item numbers 16401 (Initial Consultation) and 16404 (Subsequent Attendance) shows the situation in stark relief.
In the seven years to 2016/17, an average of 12% of women who had an initial consultation with a specialist obstetrician did not pursue private obstetric care.
In 2019/20 this percentage had increased to 46%.
And, by 2021/22, over 52% of patients attending an initial consultation with a specialist obstetrician, did not attend a subsequent appointment.
Meaning that in the past year alone, approximately 55,155 women did not pursue the private care they had been considering and were instead cared for by public hospitals.
We know what this means in practical terms for our specialty and the patients we care for:
- Private specialist O&Gs are opting out of obstetric work and working in gynaecology and fertility only.
- Specialist O&Gs are pulling out of regional areas as without private work it is uneconomical to stay in practice.
- More patients are attending under-resourced public hospitals causing some of them to struggle to retain trained staff and leading to mass walk outs and even closure of public units . All the while private hospitals have empty wards and continue to close due to under utilisation and loss making.
- The career path for trainee O&Gs is narrowing, making the specialty overall less attractive.
- There is too much pressure on rural GP Obstetricians when they lack any specialist back up, making their sub-specialty less attractive.
Despite this issue having been recognised and briefly addressed at a Federal level, the disastrous repercussions are being felt by the States.
Private maternity wards closed in Gladstone, QLD in 2018. By June 2022 the public hospital was in a workforce crisis and on bypass for maternity. The QLD health department’s solution of telling women to drive to Rockhampton to have their babies, resulted in added pressure on the Rockhampton Hospital, the subsequent resignation of overworked staff and a further reduction in access for women in the district.
Tamworth, NSW lost their private maternity hospital in 2012. O&G care at the Tamworth Public Hospital is now provided largely by locums, meaning patients have no continuity of care and the risk of associated adverse outcomes increased unnecessarily.
Everyone surveyed agrees that a continuity of career model led by trained obstetricians, offers the best outcomes for women and only an obstetrician is able to safely effect delivery in ALL situations.
Blacktown Hospital in NSW became so overwhelmed by the number of patients they could not always provide timely emergency care with tragic results, a staff walkout and national media attention.
In Geelong, VIC, the Epworth has recently announced the closure of their maternity unit, citing workforce shortages. Once again forcing more women to deliver in the public system.
NASOG developed a plan in 2021 to increase the MBS Rebate for Item 16590 (pregnancy management fee) to significantly reduce out of pocket costs for patients and encourage more people back into the private system.
Private insurers also need to better support Australian women. Ideally, pregnancy cover should be included in all policies or at the very least, an option similar to mental health inclusions should be adopted so women can raise level of cover once in their lives by waiving the waiting period.
We continue lobby hard for the removal of the blatant discrimination in Private Health Insurance premiums for reproductive health that our federal government allows to continue unchallenged..
These are solutions that only the Federal Government can implement. While they continue to do nothing, the States are floundering about with alternative workforce ‘solutions’ that at this stage, can be nothing more than a short-term fix.
Members already know that NASOG plays a vital role in political advocacy for profession. At the heart of what we do are some core principles;
- Maintain access and affordability for patients to all levels of O&G services in Australia.
- Ensure the survival and success of O&G as a specialty into the future.
The NASOG Council is unanimous in the belief that we must use every endeavour and all our available resources to fight for these principles.
You can support our fight to have this crisis addressed at a Federal level. You can lobby your local Federal Members and Senators (contact firstname.lastname@example.org for material), you can become a NASOG member or you can contribute to NASOG’s fighting fund to help us keep the pressure on (find more details at www.nasog.org.au)
It is essential that the Federal Government addresses the Obstetric Crisis with all the tools available and does not abandon the States, our profession and Australian families.
A/Prof Gino Pecoraro