Andrea
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Pressure to deliver - the private crisis
By Ruth Pollard, Health Writer August 23, 2003
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.
But it was not just medical indemnity that was driving the doctors away, it was the constant pressures of practice and its impact on family life, a survey by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists found.
The college's president, Andrew Child, said the drift from private practice illustrated a cultural change within the profession.
"It is that commitment in private obstetrics to being available 24 hours a day, seven days a week
for your patients, particularly for solo practitioners, that affects people," Dr Child said.
"It is possibly a generational thing: the concept of being on call 168 hours per week is something that the younger generation just won't consider."
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When obstetrician Amanda Dennis and her husband decided to have a family, she knew she could not balance her family life with private practice on-call work. She quit private obstetrcs on July 1 and now practises in the public system.
"I could not . . . be on call 24 hours a day and be pregnant or have a young child, even with a nanny even if my husband was prepared not to work.
"My life was chaos most of the time . . . now I go home after work and that's it, unless I am on call, which is about three days per month."
Medical indemnity was also a consideration; for Dr Dennis, it was her largest practice expense. In 2002 her premium was about $100,000 and in that year she delivered 200 babies. On top of that, she had to buy $50,000 in tail cover for any future claims when she retired from private practice. "Ultimately you have to put it on the bill to the patients," she said.
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.
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