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Stopgap solution for Tamworth’s precarious ophthalmology situation

Tamworth and its surrounding region have narrowly avoided an ophthalmology care crisis after the health department granted a six-month extension for an ophthalmologist who was about to leave due to a “flawed policy” controlling workforce distribution.

Dr Kayvan Arashvand, an ophthalmologist who completed his training in the UK and moved to Australia in 2014, has had his Medicare Provider Number (MPN) to practice in Tamworth extended until July 2021. It gives the region a temporary reprieve from an impending shortage that would’ve seen its ophthalmology services cut in half.

Arashvand has been one of four eye doctors in Tamworth. However, the ophthalmologist he works under at North West Eyes, Dr David Moore, recently turned part time. The third works full time but is approaching retirement, and the fourth was a part time locum who returned to New Zealand this month.

Dr Kayvan Arashvand.

Arashvand’s original, temporary MPN was to expire this month. Because he’s an international medical graduate under health law, he is required to work in a designated District of Workforce Shortage (DWS) for at least 10 years, which excludes Tamworth – a point advocates say doesn’t match the reality.

Because of this, he wouldn’t have been allowed to practise in Tamworth, which would have seen the city’s ophthalmology services fall from three fulltime equivalent ophthalmologists to 1.5, to service a population of 220,000 people. The city has also provided emergency after hours eyecare for 70 years, but this also faced uncertainty.

Tamworth regional councillor Ms Juanita Wilson told Insight the Department of Health recently extended Arashvand’s MPN after local MP Mr Barnaby Joyce discussed the matter with Federal Health Minister Mr Greg Hunt. She said RANZCO also intervened.

“I am delighted and relieved for a couple of reasons. Firstly, that the region will retain an adequate level of ophthalmologist services, despite it being a temporary extension. This has also allowed emergency services to remain locally rather than patients being transferred hours away to Newcastle or Sydney. This was particularly important over the holiday period,” she said.

“Secondly, it indicates that the plight of both the specialist and this region has been recognised. However, one hopes this will highlight to the Commonwealth Department of Health the inadequacy and inequity for regional Australia of the ‘postcode system’ in declaring Districts of Workforce Shortage.”

‘Flawed health policy’

At the heart of the issue is the government’s use of postcodes to assign MPNs and determine workforce distribution, which Wilson says disadvantages regional communities.

Juanita Wilson.

For example, Arashvand could have a permanent MPN to practise in a metropolitan suburb a short distance from an eye hospital, but not in a regional area like Tamworth. This is because Federal Department of Health believes Tamworth is not 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 in the Tamworth-Gunnedah region.

In reality, Wilson said the Tamworth ophthalmologists treat a population of 220,000 – more than 2.5 times the size – with 60% of patients coming from outside of the Tamworth postcode across New England, North West Slopes, Upper Hunter and Upper Central West.

What’s more, under DWS rules Arashvand would have been eligible to move to a satellite clinic 20km away from Tamworth, but would have been refused access to the hospital to perform surgery because it’s in a different postcode.

Interestingly, the government has established a Distribution Advisory Group to review the methodology used for the DWS specialists and advise whether it’s use is appropriate.

Wilson hoped the Tamworth situation could be rectified in the review, however it is unclear if this would be completed before Arashvand’s temporary MPN expires in July.

“Surely a focus of the Commonwealth Department of Health should be how to attract and retain specialists in regional Australia,” she said

“It’s ridiculous in these times, for us to be expending time and energy trying to intercept a flawed health policy that removes specialists from where there they are needed most. Also, in this case in particular, where an urgent need exists and the specialist wants to live and practise.”

Dr David Moore.

Moore told Insight the region has advertised on and off for years to attract an ophthalmologist, but no one was prepared to stay permanently, except Arashvand. It was hoping to increase the workforce through fly-in fly out eye specialists this year.

“They need to change the criteria for what’s an area of workforce shortage and allow country towns that service large areas outside the town to be deemed that, rather than just the postcode they service,” he said.

“At the local level for us, we will try get a permanent exemption for Dr Arashvand to stay because we have been unable to attract anyone else. General surgery in Tamworth was in the same boat and the hospital was able to get a South African surgeon permanent status, but we just haven’t been able to get the same headway with ophthalmology.”

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