Last doctors at Palmerston North Hospital’s gastroenterology service to leave

Source: Radio New Zealand

• Last remaining doctors at Palmerston North Hospital gastroenterology department to leave
• Concerns expressed about post code lottery for patient care
• Health NZ says it’s filling gaps at the department using staff from around the country, and recruiting new specialists

Doctors at a regional hospital are warning the postcode lottery is still alive in New Zealand’s heath system, after recruitment problems have driven one department to the brink.

Only two doctors remain at Palmerston North Hospital’s gastroenterology service, which focuses on patients suffering from problems with their digestive systems.

Of the two, one is about to finish and, now, the other one said he’s going to leave because of the workload and working conditions.

Health NZ said it’s covering gaps in the service while it recruits replacements.

Workload too much – doctor

Dr James Irwin was one of two gastroenterologists left at the hospital – the other was about to leave for another job.

Irwin, a member of the Association of Salaried Medical Specialists union, said that would leave too much work for just one full-time specialist.

“I’ve essentially made the decision that I’ll leave my position at the hospital.

“I’ve worked for Te Whatu Ora-Health NZ for 26 years. It’s not a lightly taken decision. However, I don’t see a future where it’s going to change, so I need to position myself where I’m able to work and have a volume of work that’s manageable.

“The amount of work that falls on me is too much to consider doing in the long term, so I’d need a number of colleagues to manage this.”

The gastro department was funded for 5.6 full-time equivalent positions, according to answers to parliamentary questions asked by Palmerston North MP Tangi Utikere, of Labour.

The two doctors there now cover 1.6 full-time equivalent positions. On January 1 there were 3.6 permanent employees.

Last summer there was public outcry when surveillance colonoscopies at the hospital were paused.

They had resumed, but permanent specialists had left, leaving locums to plug the gaps.

Irwin said they could do endoscopy procedures, which were also moved to private providers, but the real gap when he left would be patients requiring care for chronic conditions, such as irritable bowel syndrome.

“Postcode lottery’s been a phrase that’s always brought up at election time in New Zealand.

“I think it’s a great term to describe the desire to provide an equitable service regardless where one lives. Over the last five years the postcode lottery has worsened and deepened.”

Irwin had written to Health NZ, pleading for competitive pay and conditions at the regional service, and a manageable workload, so people were attracted to working there.

He was yet to be persuaded that anything would change for the better.

“For me to really muck in and really be part of a recovery I need hope for a recovery, for a future for the department.

“For me it means recruiting people here. It means recruiting New Zealand trainees to Palmerston North. We really have very little likelihood of doing that.”

Saddened by decision to leave

Recruitment to regional areas was hard, as medicine became more international, and Irwin estimated 40 percent of New Zealand trainees didn’t enter the workforce in the country.

“Those things mean that it’s really difficult to recruit and retain gastroenterologists in New Zealand.

“We’ve suffered that, and then not been able to replace people that have become unwell. Those that have remained have realised that it’s not going to change unless there’s a major change in the way health is delivered in our country, and they’ve gone to greener pastures.”

Irwin’s unsure of where to next for him.

It could be private practice work or doing some sessions in the public sector, such as endoscopies, but not having responsibility for referrals, recruitment and retention.

“I feel really sad about it. I’m 51 years old and my life since I was about 20 has been working towards providing healthcare service to the community.

“Since I’ve been in Palmerston North, I’ve worked hard to build a gastroenterology service and deliver good care to the people of the community.

“The way things are now, I can’t do that.”

Health NZ working on recruitment

Health NZ chief clinical officer Dr Richard Sullivan said locums and doctors from other regions were filling the gaps while it recruited more specialists.

For patients with gastric bleeding, Health NZ had developed a plan where doctors from neighbouring hospitals in Wairarapa and Whanganui were called on to work in Palmerston North.

“We’ve got what we call a sub-regional model, where they’re all working together to provide that support on that roster.

“That roster’s currently functioning very well. It’s been in place a couple of months since we started to lose more of our colleague in that space.

“That runs through to the end of May and we’re just working through now to extend it out for another three to six months.”

Sullivan acknowledged the concerns about postcode lotteries, but said being able to call on doctors from other regions showed the benefits of Health NZ’s national focus, rather than the previous regional model.

“We do have a clinician starting in September, so that’s a little light of positivity, and we’re actively recruiting at the moment.

“I believe there’s been two or three interviews of different individuals who are going through the recruitment process.

“The challenge with recruiting senior doctors is that it can take many months until you can get the feet on the ground.”

Sullivan said he was closely monitoring the situation in Palmerston North, as was the entire Health NZ senior leadership, and he was visiting regularly.

He was also working with Irwin to try to work through challenges he and the department were facing, and Health NZ was looking at ways of encouraging more trainees through provincial hospitals, in the hope they would stay there and work.

Three years ago seven specialists worked there, but they’d left due to illnesses, retirements and resignations.

“Inevitably, when you’ve got no team on the ground, you need to find a solution to make sure you deliver care for patients. That’s our key focus.

“We’ll grow the senior doctor workforce and get ourselves back to a sustained environment. But, unfortunately, we’re going to have a period of many months to a year or so where we’re going to have to look for other solutions.”

Sullivan said providing care to patients with chronic conditions was tricky. Virtual appointments were possible.

Compromising care – emergency doctor

Emergency medicine specialist and union branch president Dr Thomas Carter said the hospital had felt the effects of the gastroenterology department losing permanent staff.

“Late-stage cancer diagnosis is one of those things that if we don’t have a functional service, we’re going to see more and more of.

“That’s frustrating because by the time you have a symptomatic cancer, it’s much further along. It’s often metastatic [spread].”

He’s also concerned about patients with gastro bleeds getting quick access to specialist treatment, although Sullivan had detailed the regional plan in place for this.

“With any upper or lower GI [gastrointestinal] bleeds, they can become wildly unstable,” Carter said.

“Especially with the fuel crisis right now, it becomes incredibly important that you can treat them locally.”

If that option isn’t available medical staff would have to organise a helicopter or transport to nearby hospitals – still hours away.

Carter said the emergency medicine team had faced struggles in the past year to get specialist help for gastro bleeding.

“If there is not someone available locally, then some of the patients are going to perish.

“As much as that is hard to talk about, it’s the truth, and it’s why doctors talk about moral injury and talk about having to deny care.”

Denying care to chronic patients would mean dramatic falls in their quality of life.

Carter agreed with Irwin that this was an example of the postcode lottery, as specialists were effectively incentivised to work elsewhere, where pay and conditions were better.

‘Needs to be sorted, now’

Utikere said it was always challenging to attract people to regional centres, but Palmerston North Hospital had long been aware of the shortages in the department.

“That is deeply concerning for residents in Palmerston North. As a regional hospital it needs to be fully staffed.

“I’ve asked local management at the hospital about this and they tell me that this is the most serious threat to Palmerston North Hospital.

“It needs to be sorted and it needs to be sorted, now.”

Malcolm Mulholland, of Patient Voice Aotearoa, said health authorities needed to be upfront with the community.

“Why has this happened when we knew there was a lack of staff in gastroenterology almost a year and a half ago?

“Everyone saw this coming, everyone that is apart from MidCentral, Health New Zealand, and the government – those who are in charge of our health system.

“The time has come to have a meaningful conversation with a plan to get us out of this mess. Without it, people will die,” Mulholland said.

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– Published by EveningReport.nz and AsiaPacificReport.nz, see: MIL OSI in partnership with Radio New Zealand