'Nothing is working' - Health says doctor shortage at crisis point and not just in Parkes

'Nothing is working' - Health says doctor shortage at crisis point and not just in Parkes

Representatives of the Western NSW Local Health District (WNSWLHD) sat down with the Parkes and Forbes newspapers this week to discuss the situation the health district has found itself in, and what it is endeavoring to do to rebuild maternity services in Parkes.

The Parkes Maternity Unit was closed in June due to a shortage of obstetricians with all maternity services currently being offered at Forbes Hospital.

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The health district said at the time the closure was "disappointing" and "temporary".

Chief Executive of WNSWLHD Scott McLachlan said there is nothing new in the struggle to recruit doctors.

"I really did believe that we could get to a point of having a new workforce before now," he said.

"Just late last week, all of the rural chief executives of the local health districts in NSW agreed that this is the single biggest issue facing all of our districts.

"We are all saying this is the crisis point for us, it isn't just Western NSW and it isn't just Parkes and Forbes.

"We are pulling in all of our medical directors, the Rural Doctors Network, a lot of the different national bodies in three week's time. We've cancelled everything and said we've got to get in the room and find some solutions to this."

Director Rural Health Services Ms Sharon McKay said for quite some time now the health district has been relying on locum doctors but they are becoming increasingly harder to secure and it is not clear why.

"There were quite a few of them around because it did become a nice way of life for a doctor where you don't have to worry about a private business," Ms McKay said.

"You sign up to be a locum, we fly you in, accommodate you, we pay you, you do a week's work, and you can probably have a week off.

"Often it is a lifestyle thing. At the moment there is a real shortage of them for some reason and we don't understand what's happening."

Ms McKay said it's not just in obstetrics, but emergency medicine as well.

"We have quite a few facilities in our district at the moment where we are providing health services in a virtual manner," she said.

"We have remote general practitioners that support our EDs and inpatients."

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The problem doesn't stop with a shortage of locums though, the rates they charge is also an issue.

Mr McLachlan said locums may be "leap-frogging the prices".

"For example, they'll ask us what are we willing to pay, we'll say $3000 a day, [then] they'll go to Mount Isa and [find out how much they'll pay there].

"It's not just across NSW, but across Australia.

"In the last two to three years, the rates have just gone up and up and up."

Ms McKay said contrary to community speculation the health district did foresee the problem and has made every effort to recruit doctors to town.

"Now we have to fess up, nothing is working, we've tried, we've tried, we've tried," she said.

"Other organisations have been trying to solve this as well, this is the complexity of health in rural regions."

Mr McLachlan said compounding the problem is a new generation of doctors who don't want to be on call 24/7.

"The doctors of today aren't the same as the doctors of 20 and 30 years ago who would do seven days straight on call," he said.

"And so trying to recruit in when we've only got a couple of local doctors that are doing the oncall isn't attractive for someone to come and move into.

"You need a core group that is big enough to share the responsibility around and isn't reliant on one or two people."

Mr McLachlan feels another contributing factor is that doctors don't want the responsibility of a private business.

"Doctors of the future don't want to run a practice, they want to come and be a doctor," he said.

"A lot of them want that walk in, walk out model.

"I think we do need to look to the future and think about how we have an entity that runs the business side of things and lets the doctors do the doctoring."

It's for this reason why Mr McLachlan said the Forbes Medical Centre works so well.

But the health district is traditionally reliant on doctors working in general practice to come to the hospital - something that has waned significantly over the years.

"Two out of the three practices in Parkes don't recruit in doctors to come to the hospital and that's one of our big issues," Mr McLachlan said.

"We've now found ourselves with permanent locums in the emergency department.

"I actually think the practice set up is one of the really key things to us recruiting in doctors."

Ms McKay said if Parkes maternity unit was to return to the service it was providing 12 to 18 months ago, it would need four GP Obstetricians and four GP Anesthetists.

"That's the number to not have an unreasonable level of oncall, that's the advice we are getting from local doctors as well," she said.

Ms McKay said the health district has had a really good response to its recent invitation for community consultations, which closes today.

"What's pleasing is we've had interest from the catchment area, not just Parkes and Forbes and we've got some dads to be as well," she said.

"We have a good cohort of aboriginal women as well so that will mean we can ensure we are meeting cultural needs.

"Over a couple of weeks we will be workshopping with groups of about 10 to 12 women and next week we'll be sending out a link to an online community survey."

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Ms McKay said the two month temporary closure period originally suggested has possibly been misconstrued.

"At this point in time we can't reliably have Parkes open because of the foreseeable unavailability of sufficient numbers of locums," she said.

"At the time we said let's have Forbes as our unit for the next two months and scramble together to see if there is any way we can open Parkes.

"That workforce hasn't come to fruition. Hopefully during the consultation period we will come up with a preferred model which we will go to the board with in September.

"Our aim is to develop a model that is safe and sustainable for the community.

"Obviously birthing at both sites is still an option but what that looks like - is it a medical led model, is it midwifery led model, that I'm not sure of yet.

"That's what we want to consult about."