A regional New South Wales area that may have its ophthalmology services cut in half within months is blaming the shortage on what it describes as a flawed system controlling workforce distribution that “disadvantages” country communities.
The city of Tamworth, 400km north of Sydney, currently has four ophthalmologists. Two are approaching retirement, with one recently turning part time. The third is a part time locum returning to New Zealand early next year, and the fourth specialist works full time under one of the retiring doctors with a temporary Medicare Provider Number (MPN) expiring in January 2021.
While the fourth doctor wants to relocate to Tamworth, he is unable to secure a permanent MPN because the area is not considered a ‘District of Workforce Shortage (DWS)’ – a point the Tamworth Regional Council (TRC) says doesn’t match the reality.
Effectively, by the end of January, local authorities say Tamworth could be reduced from around three full time equivalent (FTE) ophthalmologists to one and half, to service up to 222,000 people.
TRC councillor Ms Juanita Wilson said this will deteriorate the region’s capacity to perform much of its own sight-saving treatments, operations and emergencies. As a result, the remaining ophthalmologists will be stretched, with many patients required to travel to Sydney (400km) or Newcastle (280km) for care via road or airlift.
A ‘ridiculous’ situation
At the crux of the issue, according to the TRC, is the Federal Government’s “flawed” use of postcodes to assign MPNs and determine workforce distribution.
A Federal Department of Health spokesperson told Insight Tamworth is not considered to be a DWS because its ratio of ophthalmologists to population “is well above the national average”.
The government’s numbers indicate there are 83,443 people included in the Tamworth-Gunnedah region, but it doesn’t publish the specific FTE to population ratios.
In reality, Wilson said the ophthalmologists treat a population of 220,000 – more than 2.5x the size – with 60% of patients coming from outside of Tamworth across New England, North West Slopes, Upper Hunter and Upper Central West.
“The use of postcodes may be appropriate to achieve a spread of specialists across metropolitan areas, but in regional areas it results in a small number of specialists being required to work unreasonably long hours in order service large geographical areas,” Wilson said.
“The ridiculous situation for Tamworth is that a doctor could move to another postcode 10km away in another village, but they won’t have access to the hospital to perform surgery because it’s a different postcode.”
Wilson said having a ‘District of Workforce Shortage’ designation matters for Tamworth because the fourth ophthalmologist who has a temporary MPN is keen to establish himself there. He has Australian citizenship, worked in England for 10 years and Australia for six years, and also has Australian and English fellowships.
But because he is an international medical graduate under section 19AB of the Health Insurance Act 1973, he must work in a DWS for at least 10 years, which excludes Tamworth.
Only available solution blocked
Alternatively, Tamworth has spent a lot of time and money trying to attract an eligible ophthalmologist to the region to no avail.
“The issue is even more obvious when we have fully trained specialists that actually want to move to the regions but are unable to do so because they cannot obtain an MPN due to the need to obtain exemptions from the minister under s19AB,” Wilson said.
“[The Federal Government] is not prepared to factor in issues that impact and set regional and rural areas as significantly different from metropolitan areas. The main one of course being distance. This means a neighbouring health districts in a metropolitan situation may be 10 minutes away, while regionally that can mean five or six hours away. The situation needs to be responded to in real terms, not paper terms.”
She continued: “They appear not to recognise the impending critical medical situation in this regional NSW district, and are even less interested in responding to the needs of this regional area despite there being a solution available.”
At a recent meeting, the TRC agreed to submit a motion to raise the issue at the Local Government New South Wales (LGNSW) annual conference on 23 November.
Ultimately, it wants LGNSW to make appropriate representations to the state and federal government health ministers to ensure a current review of the National Medical Workforce Strategy – and in particular how a DWS is determined when allocating MPNs – provides flexibility and opportunities for practitioners to relocate to regional and rural communities so that they are not disadvantaged in delivering essential medical services.
The Federal Department of Health spokesperson said if there are workforce changes that affect the average, this will be picked up in the next DWS update 1 July 2021.
The government has established a Distribution Advisory Group to review the methodology used for the DWS specialists layers and advise whether it is appropriate to continue using the current methodology. This review is under way.