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Surgeon shortage threatens regional health
Old 26th November 2009, 07:00 PM   #1
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Default Surgeon shortage threatens regional health

By Bronwyn Herbert

A critical shortage of general surgeons in emergency wards across the country is threatening the 7 million Australians living outside metropolitan areas.

General surgeons are required to deal with almost any surgical emergency, from hernias to hip replacements, and are the essential ingredient in keeping full-scale surgical care operating effectively in regional areas.

Without general surgeons on call, emergency services are limited as most interns will not do complicated procedures like colonoscopies, and people have to travel to the city to access surgery.

Medical trainers say the next generation of doctors are opting for roles in repetitive surgery because they earn better pay and are rarely called in after hours.

Dean of Medicine at James Cook University, Richard Murray, says data provided by the Australian College of Surgeons to the medical training review panel shows an alarming trend.

"In 2007, there were 211 new fellows of the College of Surgeons - that's newly trained surgeons coming out of training - of whom only two were reported to be general surgeons, and that's just quite an astonishing 1 per cent," he said.

Incentives lacking

Surgeon Russell Stitz from the University of Queensland says the right incentives are not in place to keep surgeons interested in generalism.

"The orthopaedic surgeon will say 'it's much easier for me to be just a shoulder surgeon or a hip surgeon', then they can say 'well, I'm losing my skills for acute trauma, I couldn't be on that roster'," he said.

"So it's very important that we create an environment where the generalists are considered to be equally as important. If anything they [should] have better conditions of service."

John Graham, a surgeon operating from Lismore in northern New South Wales, says only a select group of people will work somewhere knowing they will be on call more often and earn less.

"I'm trying to get someone to replace me because I've got other things I want to do," he said.

"I've been trying for a year-and-a-half and so far no-one has shown the slightest bit of interest in coming to Lismore.

"The fellows in the city generate a much better income. You go to the country, you've got to have a broader range of skill, you're going to do it heavier on call and at the end of the day, for the amount of work you do, you're actually paid less."

Funding cut

Surgeons say the Federal Government has made the problem worse by cutting successful programs that were bringing trainee surgeons into regional Australia.

Dr Stitz says the problem will only get worse with an ageing population.

"The ultimate impact is that we'll struggle to provide acute services and we're going to need that increasingly as our population ages and the population increases," he said.

"So we really have to work with governments to address this issue. It is the major challenge at the moment."

Dr Graham says cuts in funding to programs that recruit young surgeons to the country has made a bad situation worse.

"This year the Commonwealth has completely pulled that funding out, as it's done with a lot of the rural support programs," he said.

"What they've done is literally terminate all of the existing systems that were working, and the problem is you don't replace them. It's not a case of having a vacancy that you'll be able to fill later on.

"If you get a vacancy and you can't fill it, it will close, you'll lose it. Authorities, particularly in New South Wales, are very quick to save money wherever they can."

National policy emergency

With a recent surge in medical places across Australia, by 2014 about 3,000 doctors will start their specialist training.

Associate Professor Murray says regional hospitals should be turned into teaching hospitals and then rotate their interns for a stint in the city to build up a more flexible workforce.

"If this new bulge of graduates coming through the system ends up all being shoehorned into the same old same old, then we could in fact build a medical workforce that we neither need nor can afford," he said.

"There is a really urgent need, and we're saying a national policy emergency, to create the sort of regional-based rotating to the cities if need be for some specialty exposures."

A spokeswoman for the Health Minister, Nicola Roxon, says there has been no reduction in the funding commitment for rural surgical training.

Instead, the Government has consolidated the program into a single $171 million specialist training program.

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