A Road to Somewhere…..

I don’t know about you, but the past four months have had a ‘Groundhog Day’ sensation about them for me. The media in various parts of the country has continued to cover private maternity ward closures, public hospitals on maternity bypass and the stress caused to women in regional Australia by the uncertainty of where and how they are going to deliver their children.

In Queensland, the regional public hospitals cannot manage to keep obstetricians on staff and the reliance on an expensive locum workforce is increasing.

And in the meantime, highly experienced private practitioners cannot have admitting rights for their patients at the public hospital. Meaning they and their patients are left in limbo.

Across the country, private obstetricians are eager to continue to look after patients. They are committed to the regions where they are living. They are part of the community with partners working in the district and children in local schools.

They are offering to work collaboratively with local health districts and the Departments of Health to improve resources and training opportunities in the regions.

NASOG is working with members to facilitate discussions with politicians, bureaucrats and the media. Disappointingly, our members’ willingness to find solutions and bring innovation continues to fall on deaf ears.

This comes across as total disinterest in finding a genuine solution and meanwhile, public hospitals become increasingly stressed with maternity patient numbers.

MBS data tells us that in the past year, approximately 45% of patients who had an initial consultation with a private obstetrician did not pursue that model of care.

A decade ago, that number was 12% of patients.

This plays out worst in the regions, where resources were already stretched.

There’s a possibility that the health bureaucrats think that obstetricians currently practising privately will be left with no choice other than to work in the public system.

In Queensland, obstetricians have made it perfectly clear to NASOG and the health department, that they don’t want to work for Queensland Health. They believe that the system is midwife centric, with doctors only called at the last minute and where the Palaczeuk government’s introduced legislation allowing the regulator to publicly name practitioners during an investigation before any finding of wrongdoing is found, effectively removes their right to the presumption of innocence.

So instead of continuing with obstetrics, many are simply turning away to practice just in gynaecology, further worsening the overall situation.

Last month I attended the National Rural Maternity Forum, hosted by The Office of the Rural Health Commissioner, the Rural Doctors Association of Australia and the Australian College of Midwives. Amongst the 70 attendees at the event, there was very strong agreement that the situation has to change for mothers and their babies in rural and regional Australia. Outcomes included a commitment to take rural maternity care forward with National Cabinet and work with various stakeholder groups on key workforce redesign and funding, including a review and update of the National Consensus Framework for Rural Maternity Services. However, one day is not enough time to address all the challenges in bringing better access to maternity care models to the bush.

But we know that improving the integration of private/public facilities & services in regional areas is going to be key to solving the maternity crisis. We know this because our members have told us.

During June/July this year we conducted a survey, seeking feedback from members to build on previous studies and identify the key reasons that prevent O&G specialists working in regional areas.

Respondents represented 50% of the NASOG membership and reflect the current demographic in O&G with 81% female and 19% male.

The respondents were primarily from NSW (30%), QLD (30%) and VIC (20%) with 60% of them having been in specialist practice for 10 years or less.

98% had worked in a regional area at some point and 66% identified as still working regionally.

For a third of the respondents, 75% of their work was in obstetrics and 25% in gynaecology.

Of that split, 33% did 100% of obstetric work privately and 35% did 100% of gynaecology work privately.

Our regional members love the diversity of their practice and the fact that they develop and use a wider skill set. They enjoy being part of a community and getting to know their patients. They value the healthier lifestyle for themselves and their families.

But those who have left the regions have done so because there was a lack of private practice opportunities, poor support and interaction with hospital administrators and lack of investment in medical related technology, facilities & services.

So, I find myself back at the same point, asking again that the State and the Albanese government work together and urgently act to make private health insurance affordable for families and ensure that policies cover the cost of accessing treatment in the private sector so specialists can be retained in regional areas, pressure taken off already struggling public hospitals and give regional families the services they deserve.

A/Prof Gino Pecoraro

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