Until the insurance question is addressed, adding more doctors won’t stop the maternity crisis in rural areas.
Queensland has promised funding for 20 new training positions for GPs wanting to upskill in obstetrics, but some doctors say the real solution is far less sexy.
The sunshine state is in the midst of a well-documented maternity crisis as the closure of smaller public and private wards in rural towns put pressure on the health system even in fairly large regional centres like Rockhampton.
The reason for the closures are complex, but have essentially manifested as a lack of staff in public maternity wards.
Gladstone Base Hospital cited lack of staff as the cause for its 11-month maternity “bypass”, which came to an end in June.
The facility has only ever accepted low-risk pregnancies.
Last week, Queensland Health Minister Shannon Fentiman announced funding for 20 GPs to undertake advanced skills training in obstetrics, along with a review on Queensland Health locum policies and new “digital passports” to help clinicians more easily move between health systems.
AMA Queensland president Dr Maria Boulton welcomed the initiatives, but also reiterated the need for permanent obstetrics and gynaecology specialists in rural areas.
“Queensland is a very decentralised state, but we have a lot of families living in regional, rural and remote areas who do deserve better,” she told ABC Queensland.
“In most of those areas, the majority of maternity services do rely heavily on the GP workforce, but those GPs also rely heavily on the support of obstetricians in regional areas.
“And it’s important that the entire workforce is at the level it needs to be to provide those services.”
It’s this point – that even highly trained GPs do rely on the support of specialist obstetricians – that’s lead some to doubt the usefulness of additional GP obstetricians entirely.
That’s certainly the view of Associate Professor Gino Pecoraro, president of the National Association of Specialist Obstetricians and Gynaecologists.
“It’s good to be putting more money in, but in my heart of hearts, if that’s all they’re going to do, and you’re asking me ‘will that stop [the crisis]?’ The answer is no,” he told The Medical Republic.
“Because they’re ignoring the cause of it all, because it’s just too hard and not politically sexy for them.
“It’s not going to give them a photo op.”
Professor Pecoraro, whose organisation represents the interests of private practice obstetricians and gynaecologists, believes the issue at the centre of the maternity crisis is high insurance premiums, not staffing.
He makes a compelling case.
Pregnancy and maternity care tends only to be covered at the highest tier of private health insurance, making it an expensive option in a country which had a high cost of living even before the pandemic hit.
It’s not just theoretical: research from the Melbourne Institute indicates that around 25% of Australians under 35 with private health insurance dropped or reduced cover over the pandemic, as well as a third of people aged 35 to 44.
Without private patients, private maternity wards don’t last long.
“The problem that happened in Gladstone was that when they closed the private ward, the private consultants left and took away the support that they gave the GP obstetricians,” Professor Pecoraro said.
“Everyone was forced to go publicly, but the public hospital wasn’t staffed or built for it.”
Here’s where insurance raises its ugly head again, this time in relation to medical indemnity.
“Currently, doctors get called in at the last minute when it’s all gone pear-shaped,” Professor Pecoraro said.
There’s an existing body of evidence to suggest that obstetrics and gynaecology is a frequent target for litigation in Australia and Professor Pecoraro said some specialists felt they were only called in to “crisis manage” and for their insurance policy.
Without the specialists as backup, Professor Pecoraro said trained GP obstetricians were less certain of their work.
“Once you get out of the major capital cities, the vast majority of babies are actually delivered by GP obstetricians – they’re a very important part of our workforce,” he said.
“It’s much more reassuring, if you’re a GP obstetrician, to know that you can call a friend in an emergency.”
He also claimed that existing ACRRM places for advanced skills training in obstetrics were being left empty in Queensland, in favour of advanced training in paediatrics or anaesthetics.
ACRRM did not respond to a request for comment.
