Reduced Options For New Zealand Women

Reduced Options For New Zealand Women

New Zealand’s obstetricians are abandoning private practice at a significant rate and the exodus will worsen over the next five years.

Within five years, only eight (8) per cent of New Zealand’s 188 specialist obstetricians and gynaecologists will be running a full-time private practice. The current figure is 18 per cent.

The drift away from private obstetrics appears to have two principal reasons – the need to reduce the stress on these doctors’ lifestyles, and the ever-present threat of legal action if there is not a perfect outcome.

These are the main findings from a comprehensive survey of Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the professional education body of specialists in women’s health. More than three-quarters of the college fellows participated in the workforce survey earlier this year.

Dr Andrew Child, President of RANZCOG, said that the workforce survey showed that in general Australian and New Zealand gynaecology and other sub-specialty services provided by college fellows were in good shape, although many doctors were working long hours. But the picture in obstetrics was troubling. The survey showed that in New Zealand just 18 per cent of Fellows practiced private-only obstetrics with another 31 percent practicing both private and public obstetrics. Already, 50 specialists have quit private practices in the past three years. But some of these had a mixed private-public practice before they abandoned private deliveries. Expectant mothers will have to rely increasingly on strained public hospitals services, private midwives, general practitioners or a dwindling number of private specialists, he said.

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2 Dr Kenneth Clark, New Zealand Vice-President RANZCOG said: “General lifestyle issues appear to be the most significant factor. The stress of being on-call 24 hours a day, seven days a week, is not appealing to the emerging generation of specialist obstetricians and the older ones have had enough.

“It seems many doctors can no longer tolerate making great personal sacrifices, but still practice under the growing threat of being sued and tied up in the courts for years when the outcome is anything less than ideal.”

A growing percentage of younger obstetricians are female. Thirty four per cent of NZ fellows are female with higher percentages in the younger age group, and they need time to devote to their own children and families, Dr Clark said. This need was also relevant to an increasing number of male obstetricians.

It was becoming increasingly difficult to attract trainee obstetricians. A significant number of trainees had to be sourced from overseas, and these obstetricians were not necessarily looking for long-term careers in New Zealand, he said.

“So while we have significant numbers abandoning private practice, we have a real problem producing new specialists from the trainee systems,’ he said.

Dr Clark said:” This survey shows that a key component of our system is diminishing at a rapid rate. What is going to replace it? Will public hospitals be able to respond to the extra demands? Will New Zealand mothers be satisfied with the alternatives, even if they can be provided? Is there a plan for more services in public hospitals? Can we further encourage the team approach? These questions have to be addressed with New Zealand’s mothers so they can continue to give birth to healthy babies with confidence.”

Dr Clark said the community and the profession needed to consider alternative models of medical obstetrics practices, including group practices where a number of specialists shared responsibility for coverage and care.

The survey showed that a disproportionate number of specialists intending to quit private obstetrics operated from solo practices rather than group practices or partnerships where assistance was available.

Dr Clark said this approach needed to be accelerated and younger obstetricians needed to be encouraged to form group practices to share the workload. He said there were already a number of examples of group practices in which specialists were able to stay in the profession by sharing the round-the-clock responsibilities

Other findings of the survey included:

The percentage of RANZCOG fellows in Australia and New Zealand (obstetricians and gynaecologists) aged over 60 had increased from the last survey in 2000 and the percentage under 40 had decreased. A quarter of fellows are aged 60 and over. ….3 3 There was now a slight majority of female fellows in the 30-39 age group. In the profession as a whole, female fellows had grown from 21 per cent in 2000 to 23 percent in 2003.In New Zealand alone there are 34 per cent females.

Fellows in their 30’s were less likely to be practising obstetrics in the private sector than those in their 40’s and 50’s. Females across all age groups were less likely to practice private obstetrics than males.

Total hours worked in the week of the survey was a median of 51, compared to 50 in the last survey in 2000, with females working, on average, five hours less than males. Specialists in their 30’s and 40’s worked fewer hours than those in their 50’s.

More than half the specialists had at least one night’s sleep interrupted by the needs of a patient during the week of the survey and 18 percent had three nights or more interrupted.

There are about 188 specialists actively practising obstetrics and gynaecology in New Zealand. 136 are practising obstetrics and only 25 are practising private-only obstetrics.

Dr Clark emphasised that the RANZCOG supports a collaborative approach to obstetrics, acknowledging the valuable contribution made by all members of the team – specialists, general practitioners and midwives. Such a collaborative approach should result in women being provided with the best possible range of options when choosing their obstetric care.

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