August 23, 2003

The state of private obstetrics in Australia

As the pressure builds to reform maternity services in Australia, there seem to be an increasing number of media stories that try to paint the obstetricians as the victims of fickle women and unsympathetic Governments. Their lobbyists have always had good access to the media, and whenever a question is raised or a report released that challenges, even gently, the status quo, the media trot out a “poor me” story about some struggling obstetrician who is just “trying to save babies” in the face of hostility and political ill-will.

Of course, what is really going on is that the doctors are starting to feel the blow-torch of public scrutiny over their management styles which invariably result in over-servicing of pregnant women and high rates of intervention in birth. The reports that have been released in recent years and the excellent research that has revealed the truth have made this abundantly clear.

In today’s major Australian weekend newspaper, the Sydney Morning Herald, is yet another such media beat up. This story, once again about doctors leaving the private health care system, places the blame on long hours and being on-call 24 hours each day. Whilst this is a genuine concern for many obstetricians, especially the women who have chosen this profession, the regular complaints about insurance are once again cited as a reason. The most interesting part of the report are the figures, which must be read in the contact of an annual birthrate in Australia of 250,000 babies:

'Almost half the country's obstetricians are planning to abandon private practice in the next five years, affecting the delivery of up to 17,000 babies by 2008. Some will enter the public hospital system and others will practise gynaecology and related specialties.
Doctors are also warning that the public hospital system will be increasingly struggling to meet the demand created by the exodus of private obstetricians.
"If we get another 16,800 babies in the public hospital system, which is the amount of births we would expect to handle in the next few years, there will be strain," Dr Child said.
Specialist obstetricians are also quitting public hospitals. The survey found 100 intended to quit the system in the next five years. Of the 1162 specialists practising obstetrics and gynaecology around the country, less than half practise obstetrics and only 300 are in private practice only. Already, 150 specialists have quit private practice in the past three years, and 55 said they intended to stop private practice in 2003, the survey found. Over the next five years, another 150 will cease practice.
While medical indemnity was not nominated as the main reason for leaving the profession, 10 per cent of those surveyed reported paying premiums of more than $98,000 in 2001-02.
"One issue is the affordability, but there is also the ogre of this hanging around in the background, whatever you do," Dr Child said. Ultimately, it meant it was increasingly difficult to get a private practitioner, with rural areas suffering most, he said.'

I feel sure our public health care system can easily cope with another 16,800 babies being born in our public hospitals. With a change in Government policy these women’s maternity needs could easily be catered for by independent midwives!

I have always believed that the obstetricians would eventually price themselves out of private obstetric practice one way or another. Despite their protestations of other reasons, I think this si starting to happen, and rather more quickly than many of us had hoped.

Posted by andrea at August 23, 2003 09:31 AM

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