An overseas-trained ophthalmologist whose ability to practise in Tamworth was under threat due to workforce distribution policy has been granted another extension until 2022, as work continues towards a permanent solution for an issue affecting many medical fields.
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 work in the regional NSW city – at North West Eyes – extended until January 2022.
It is the third time he has been granted an extension and gives the region some certainty after he was almost required to leave, potentially triggering an ophthalmology shortage.
The Australian Society of Ophthalmologists (ASO), with the support of RANZCO, has been instrumental in working with the Federal Government to secure the extensions.
“This is a stopgap measure that will keep Tamworth safe for the rest of the year, but we are continuing our very strong efforts to ensure we don’t have to keep coming back every six months begging to keep an ophthalmologist who the community really wants to hang on to,” ASO president Associate Professor Ashish Agar said.
“We are now working very closely with the federal health minister and health department to get a long-term solution – and not just for Tamworth, this is a national issue that affects every branch of medicine.”
At the heart of the matter is the government’s District of Workforce Shortage (DWS) mechanism to determine the equitable distribution of specialists in Australia. A DWS is a geographical area in which the local population has less access to Medicare-subsidised medical services when compared to the national average for a specific service.
Because Arashvand is an international medical graduate under health law, he is required to work in a designated DWS for at least 10 years. Tamworth doesn’t have DWS status, but Agar said this is because the calculation was based on the city’s population, rather than the wider catchment.
To highlight the discrepancy, the government’s figures indicate there are 83,443 people in the Tamworth-Gunnedah region, when in reality Tamworth’s ophthalmology services cater for around 220,000 people. If Arashvand left, Tamworth could have been left with the equivalent of 1.5 full-time ophthalmologists.
Agar said it was important for Tamworth to retain Arashvand because it wouldn’t have had the capacity to provide other services. For example, the city has offered emergency after hours eyecare for 70 years, but this would have faced an uncertain future.
“If he leaves, the whole thing falls over, they won’t be able to do on call, and they won’t be able to retain their registrar as well, the implications are huge,” Agar said.
“We’ve lodged submissions with the government to offer solutions that work towards addressing the underlying limitations of the current DWS assessment system.”
Agar is hopeful the matter can be addressed, with the government examining the issue through a Distribution Advisory Group. It’s currently reviewing the methodology and will advise whether it is still appropriate.
In a September communique, the group said the DWS methodology calculates that any specialty group with a ratio greater than three full time service equivalent (FSE) per 100,000 population is not automatically classified as a DWS. It said this ratio was “arbitrary”.
Hope for change
Dr David Moore, who founded North West Eyes in 2003 and employed Arashvand, said the decision provided some certainty.
“Dr Arashvand can practice in this region and actually settle down rather than living in Airbnb accommodation which he has been doing the past 16 months,” he said.
“For me, it means that we have him as one of very few ophthalmologists in the region which drains a large part of our state and is chronically undersupplied. He has become widely liked and respected by patients and staff alike.”
Moore hoped, in future, the assessment that determines an “area of need” will be changed to reflect the actual area and population numbers that a specialist covers.
“This should include all specialities and truly consider the vast distances that rural based specialists cover,” he said.