Who will deliver the next generation of Australians?

Sunday, 5 May 2002

The alarming results of a recent survey of Australia's specialist obstetric workforce will be published in the latest Medical Journal of Australia on May 6, 2002.

The paper, titled "Projections of Australian obstetricians ceasing practice and the reasons", is the result of the unusual research combination of a lawyer and an obstetrician: Professor Alastair MacLennan from the University of Adelaide's Department of Obstetrics & Gynaecology and visiting academic with the department, practising lawyer Mr Michael Spencer.

Their survey shows that only 24% of current obstetricians intend to still be in practice in 10 years.

"Retirement rates will greatly outstrip recruitment rates, leaving inadequate numbers to provide Australians obstetric services," Professor MacLennan says.

"Although fear of litigation and enormous indemnity costs are dissuading new and old obstetricians from practicing obstetrics, our survey also showed that long hours, disruption of family life and poor job satisfaction in the public system also contributed to their wish to turn to gynaecology rather than obstetrics.

"The situation is compounded by the fact that the current obstetric workforce is ageing and 81% are male. However, among trainees there is a gender shift, where 55% are female, many of whom wish to practice little or no obstetrics and prefer the lifestyle of a gynaecological practice."

Professor MacLennan and Mr Spencer say part-time and new obstetricians are particularly dissuaded by the rapidly escalating medical indemnity costs for obstetricians that have risen from $100 in 1980 to more than $100,000 in New South Wales in 2002.

"Two thirds of obstetricians surveyed were aware of potential litigation against them during their career," Mr Spencer says.

"A recent award in a case involving cerebral palsy amounted to over $14.2 million. This and similar cases are threatening the financial viability of medical indemnity providers."

The authors say there are no effective policies around labour to reduce cerebral palsy rates, and many cerebral palsy cases are due to difficult-to-identify silent causes during pregnancy, such as infection. Many doctors are calling for a no-fault system to award automatic pensions to children born with cerebral palsy and perhaps other congenital neurological disorders.

"This would eliminate some cases of lengthy (up to 25 years), expensive litigation that is traumatic to all parties concerned," Mr Spencer says.

"The effects of the current tort system and problems funding indemnity are now going to be felt by Australian parents-to-be, with few specialists left to deliver the next generation. Midwives too are subject to the same problems of litigation, insurance and recruitment and cannot be expected to cope alone."

Professor MacLennan and Mr Spencer offer some possible solutions, such as:

• the appointment of experts by the court to improve the standard of medicolegal opinion
• the training of obstetricians separately from gynaecologists
• a no-fault award system for those with neurological disabilities
• better systems for dispute resolution and medical review without the need for civil litigation
• team midwifery/obstetrics, where responsibility and continuity of maternity care are shared.

Professor MacLennan warns: "Without urgent action, country and private obstetric practice will rapidly disappear, and the public metropolitan maternity hospitals are likely to be unable to cope due to insufficient facilities and staff."

Contact Details