Whose Hospital Is It Anyway?

Sometimes I wish I could just get on with the business of being a doctor. Like other rural clinicians I am trying my best to bring ‘quality care, out there’.

In a model sanctioned by the CEO of CountryHealthSA, for the past 2-3 years KI doctors have been providing 24/7 on call services all year for both obstetrics and anaesthetics. For the more onerous emergency on call roster, a deal was reached whereby KI doctors were contracted to provide 3 weeks in every month, with the remaining week covered by a locum provided by Country Health SA. Of course our private clinic practice continued as usual Mon-Fri all year, public holidays excepted.

Put simply, the Island doctors did as much of the emergency on call work as they were able with the number of doctors available, with the Health Department filling in the remainder. After all, it’s the Health Department’s hospital….

Govt to pay for a locum one week per month … or 52 weeks per year?

With the new contract for SA rural doctors, Country Health SA has insisted that, rather than work a manageable 3 weeks in 4, instead KI docs take on 365 day emergency medicine cover despite the fact that we have insufficient doctors and the fact that the current model works well.

Their rationale? Paying for a locum costs the Health Department. So they would like to pass full responsibility for the A&E roster to the single practice on Kangaroo Island…even if it means that the KI doctors pay for the locum relief themselves. They suggested we pay $10,300 per week (plus GST) for a locum to service the A&E roster 1 week in 4 – a locum they currently provide.

It all comes down to a question of just whose responsibility it is to provide an on call roster at the hospital.

We met the Health Department this week and explained that this model would not work for us. Whilst we have enough doctors to manage our private practice clinic, we do not have enough of us to provide 24/7/365 A&E cover. We can do 3 weeks per month – but certainly won’t pay for a locum to man A&E when the responsibility lies with the Health Dept.

Loss of procedural services?

Their response? To threaten to disband the on call rosters for A&E, anaesthetics and obstetrics and replace the entire A&E service with locums. Anaesthetic and obstetric rosters would not be replaced. Their logic being that if KI docs could not do ‘the entire A&E roster for 365 days per year’ then it would have to be outsourced to another party.

Given that it costs $10,300 per week for a locum, that means an expenditure of $535,600 per annum to replace us with locums for A&E. Either that or set up a rival general practice using Government funds … to solve the unrelated but pertinent problem of staffing the hospital A&E.

This also feeds into recruitment and retention of doctors. Doctors with procedural skills are unlikely to move to a location where they cannot provide their services or will not be paid to be on call. Current doctors are unlikely to remain if they cannot do the same.

Dark days ahead for our community unless some commonsense prevails.