Palmerston North Hospital’s gastroenterology service is leaving the last doctors

• The last remaining doctors in the gastroenterology department at Palmerston North Hospital are leaving
• Concerns have been expressed about a postcode lottery for patient care
• Health NZ says it is filling gaps in the department by drawing on staff from across the country, and recruiting new specialists.

Doctors at a local hospital are warning the postcode lottery is still alive and well in New Zealand’s health system, after recruitment problems pushed a department to the brink.

Only two doctors remain at Palmerston North Hospital’s gastroenterology service, which focuses on patients with problems with their digestive system.

Out of the two, one is nearing completion and now, the other said he is leaving due to workload and work conditions.

Health NZ said it was covering gaps in the service while it recruited a replacement.

Too much work – Dr

Dr. James Irwin was one of two gastroenterologists who stayed at the hospital – the other left for another job.

Arun, a member of the Association of Salaried Medical Practitioners, said that would leave too much work for a full-time practitioner alone.

“I have basically decided that I will leave my job at the hospital.

“I’ve worked for Te Whatu Ora-Health NZ for 26 years. It’s not a small decision. However, I don’t see a future where that’s going to change, so I need to get myself to a place where I can work and have a manageable workload.

“The amount of work that falls on me is too much to consider doing in the long run, so I need a number of colleagues to manage it.”

The gastro department was funded for 5.6 full-time equivalent positions, according to answers to parliamentary questions asked by Palmerston North MP Tangi Uthikere, Labour.

There are two doctors now covering 1.6 full-time equivalent positions. On January 1 there were 3.6 permanent employees.

There was public outrage last summer when surveillance colonoscopies were stopped at the hospital.

They started again, but the permanent experts remained, leaving places to fill the gaps.

Irwin said they can perform endoscopic procedures, which have also been transferred to private providers, but the main gap when he leaves will be patients who need care for chronic conditions, such as irritable bowel syndrome.

“The postcode lottery is a phrase that always comes up at election time in New Zealand.

“I think it’s a good term to describe the desire to provide an equal service regardless of where someone lives. The postcode lottery has gotten worse and worse over the last five years.”

Irwin wrote to Health NZ, asking for competitive pay and conditions in the regional service, and a manageable workload, so people were attracted to work there.

He was still convinced that everything would change for the better.

“For me to really dominate and really be part of the recovery I need hope for recovery, for the future for the department.

“To me that means recruiting people here. It means recruiting New Zealand students north of Palmerston. We’re really less likely to do that.”

Regret the decision to leave

Recruitment to regional areas was difficult, as medicine became more international, and Irwin estimated that 40 percent of New Zealand students did not enter the workforce in the country.

“These things mean that it is really difficult to recruit and retain gastroenterologists in New Zealand.

“We put up with it and then we can’t replace the people who have gotten sick. Those who are left have learned that this is not going to change until there is a major shift in the way health care is done in our country and they move on to greener pastures.”

Arun is not sure where that will be for him.

This may be private practice work or perform some sessions in the public sector, such as endoscopy, but are not responsible for referrals, recruitment and retention.

“I am very sad about this. I am 51 years old and have been working to provide health services to the community since I was about 20 years old.

“Since I’ve been in Palmerston North, I’ve worked hard to build up the gastroenterology service and deliver better care to people in the community.

“The way things are now, I can’t do it.”

Health NZ is recruiting

Health NZ chief clinical officer Dr Richard Sullivan said doctors and medics from other regions were filling gaps while it recruited more specialists.

For patients with gastrointestinal bleeding, Health NZ has developed a plan where doctors from neighboring hospitals in the Wairarapa and Whanganui are called to work in Palmerston North.

“We’ve got what we call a sub-regional model, where they all work together to provide that support on that list.

“This list is doing very well right now. It’s been a few months since we lost a lot of our colleagues in this space.

“It runs until the end of May and we’re just now working to extend it for another three to six months.”

Sullivan acknowledged concerns about postcode lotteries, but said the ability to call doctors from other regions showed the benefits of Health NZ’s national focus rather than the previous regional model.

“We have a clinic starting in September, so that’s a little glimmer of positivity, and we’re actively recruiting at the moment.

“I believe there have been two or three interviews with different individuals going through the recruitment process.

“The challenge in recruiting senior doctors is that it can take months until you get your feet on the ground.”

Sullivan said he was monitoring the situation in Palmerston North closely, as was all of Health NZ’s senior leadership, and he was visiting regularly.

He was also working with Irwin to try to work through the challenges he and the department were facing, and Health NZ was looking at ways to encourage more trainees through provincial hospitals, in the hope they would stay and work there.

Three years ago, seven specialists were working there, but they were left due to illnesses, retirements and resignations.

“Inevitably, when you don’t have a team on the ground, you need to find a solution to make sure you’re taking care of patients. That’s our key focus.

“We will develop a workforce of senior physicians and return ourselves to a sustainable environment. But, unfortunately, we will have a period of many months to a year where we will have to look for other solutions.”

Caring for patients with chronic conditions was difficult, Sullivan said. Virtual meetings were possible.

Critical Care – Urgent Dr

Dr. Thomas Carter, an emergency medicine specialist and union department chair, said the hospital has felt the impact of losing permanent staff in the gastroenterology department.

“Late-stage cancer diagnosis is one of those things that if we don’t have an active service, we’re going to see a lot more of it.

“It’s frustrating because by the time you have symptoms of cancer, it’s getting worse. It’s often metastatic. [spread]”

He is also concerned about patients with gastroenteritis getting faster access to specialist treatment, although Sullivan outlined a regional plan for this.

“With any high or low GI [gastrointestinal] Bleeding, they can become wildly unstable,” Carter said.

“Especially right now with the oil crisis, it becomes even more important that you can treat it locally.”

If that option isn’t available, medical staff must arrange for a helicopter or transport to nearby hospitals – still hours away.

Carter said the emergency medicine team has had trouble getting specialist help for gastrointestinal bleeding in the past year.

“If there is no one locally, some patients will die.

“As hard as it is to talk about it, it’s the truth, and that’s why doctors talk about moral harm and talk about denial of care.”

Denying care to the chronically ill would mean a dramatic reduction in their quality of life.

Carter agreed with Irwin that this was an example of a postcode lottery, as professionals were effectively encouraged to work elsewhere, where pay and conditions were better.

‘Configuration required now’

Utikeri said attracting people to regional centers had always been a challenge, but Palmerston North Hospital had long been aware of shortages in the department.

“This is of deep concern to the residents of Palmerston North. As a regional hospital it needs to be fully staffed.

“I asked local hospital management about this and they told me it was the most serious threat to Palmerston North Hospital.

“It needs to be sorted and it needs to be sorted now.”

Health officials need to face the community, said Patient Voice Ottawa’s Malcolm Mulholland.

“Why did this happen when we knew there was a shortage of staff in the gastroenterology department almost a year and a half ago?

“Everyone has seen it, everyone apart from Central, Health New Zealand and the government – the people who are in charge of our health system.

“It’s time to have a meaningful conversation with a plan to get us out of this mess. Without it, people will die,” Molholland said.

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