To our Kangaroo Island Community,
We write to you as the three current associate doctors of the Kangaroo Island Medical Clinic.
We have chosen to write this letter to share with you our concerns about the long-term sustainability of the current medical workforce on Kangaroo Island. It has become clear that the medical workforce across rural and remote Australia is in crisis, and Kangaroo Island is no different; the situation here is only part of a wider problem. We think it is only fair to share with you just how worried we are so that, as a community, we can try to find solutions together.
As well as providing care to our patients at the clinic, our doctors also provide a variety of medical services to Kangaroo Island Health Services, our local hospital: emergency medicine, inpatient medicine, palliative care, obstetrics and anaesthesia. The doctors are not employed by the hospital, but contracted to attend the hospital when needed under a fee-for-service model.
For many decades, rural Australia has survived under such a model of care, which relies on rural doctors to be the ‘jack-of-all-trades’ looking after their local communities. It is a 24-hours-a-day, 7 days-a-week job, requiring us to balance at all times the commitment we have made to be the doctors for our local hospital (which does not employ its own resident doctors) with our commitment to our general practice. The Kangaroo Island Medical Clinic is a private business. Like any small business, we have to make ends meet: utilities and rent payments, our excellent staff to pay and equipment to maintain. Despite this juggle, it is a job that we love and it is immensely rewarding professionally. We consider it a very great privilege to provide ‘cradle-to-grave’ medicine to you, our community.
But we are in trouble.
It is becoming harder and harder to recruit doctors to rural areas like ours and we must be realistic: it is only going to get harder. There are many reasons for this – a discussion which is too big for this particular letter. In essence, medical graduates are increasingly choosing to train in specialist fields other than the speciality field of general practice. The number of doctors in more narrow specialty fields is growing much faster than the number of generalists, and this is especially seen in regional areas. This is occurring despite a recognised need for more generalist doctors both inside, but especially outside of, major cities.
Kangaroo Island has managed to maintain its medical workforce through a combination of the calling and dedication of a number of long-term doctors on KI as well as good luck: for many years, one doctor has happened to arrive just as one is leaving. But our good luck is running out. Despite our very best efforts, it has become increasingly difficult to recruit long-term associate doctors, especially those with procedural skills (namely, anaesthesia and obstetrics). We have been reliant recently on registrars (general practice specialists in training) to prop up our medical workforce on the island. This is where we have been fortunate: we have employed some truly excellent registrars over the last few years.
With Dr Wells leaving the practice in December, and Dr Steyn currently on leave for three months and then stepping down and looking at full retirement in the foreseeable future, it leaves Dr Cohen with a job that is not viable for one person to do. Without enough senior associate doctors at the helm, we will not be able to supervise and therefore employ registrars, and so the pyramid quickly topples.
The longstanding model of the local rural hospital relying on its local general practitioners to staff its emergency department, its medical wards, its maternity unit and its operating theatres, is outdated and, sadly, it is dying. This model, which asks much of each individual, is increasingly unattractive to the new generation of junior doctors forging a career, who do not have to look far to find medical jobs that demand less but remunerate more.
New models will need to be found, and already are being explored and employed across the country, with varying levels of success.
So what can you, our community, do to help?
Firstly, it is time to start petitioning our state government. We need YOUR voice, as voters. The state government knows there is a crisis, but perhaps it does not grasp just how close to the edge of the cliff we are. We have raised this issue many times with both sides of politics but there is still inaction. Both major political parties have neglected rural South Australia and rural Australia generally, as far as medical workforce is concerned, for many years. Furthermore – as an island we are, of course, particularly vulnerable. Whilst communities across the rest of the state who once had a local doctor may now need to travel hundreds of kilometres to see any doctor, at least they have a road to get there.
Secondly, we need help recruiting. Whilst the current model of medical service provision is outdated and sure to change, it is the model we work with at the moment. Appeal to whatever networks you may have, speak to friends across the country, and share our recently-commissioned recruitment video please via social media.
Thirdly, please be patient with us, and kind to new doctors that might come. We can promise that we are trying our best to look after your acute and chronic medical needs as best we can, even though we are spread very thin right now. We realise that it is difficult to get an appointment at the clinic at the time that suits you best, and this is one of the main reasons that we need and want more doctors to work with us in the clinic. In particular, we would ask you please not to take out your inevitable frustrations on our hard-working reception and nursing staff, who are also doing their level best to accommodate the health needs of the community in difficult circumstances. We think that we have wonderful staff at the clinic, and we ask you to respect them as highly as we do.
Despite the pressures that the current workforce crisis presents, we can assure you that we will continue to provide you with the very best care that we can at the Kangaroo Island Medical Clinic and at Kangaroo Island Health Services. We do think that we practice medicine at a high level – that remains our core ethos – and the well-being of the community will always remain our priority.
Dr Johannes Steyn
Dr Jeremy Wells
Dr Philip Cohen