Could the last doctor leaving rural SA close the door?

Interesting week in Adelaide – the new ‘South Australia State logo’ was unveiled at the Festival Centre. I managed to get along and, along with many others, was significantly underwhelmed.


Criticisms are that SA looks like the largest open cut mine, visible frm space…or a series of doors….or a Pope’s hat.

Regardless, it has got people talking.

Meanwh the KI Doctors are trying to get media attention for their plight with the SA Health Department. We simply cannot get any sense out of the CHSA Health Bureaucrats and are trying to get the Health Minister Jack Snelling to take action.

Latest media release plays upon the ‘doors’ theme of the SA logo. My fear is the door is closing to get a resolution on this issue.

Media interest this week in the profound wait (up to six weeks) to see a doctor in rural SA. Currently KI Docs have a mix of pre-bookable and ‘book-on-the-day’ appointments, meaning we can meet most demand on the day, and patients can see ‘their’ doctor within a few days for non-urgent consults. All this will change if CHSA do not resolve the crisis.

Read the Media Release here …. and make your own comments known by either hitting the airwaves (891 AdelaidefiveAA), writing to the media (The IslanderThe Advertiser), or telling the State Health Minister what you think.

KI Docs Dispute in the Media

I am up in Adelaide this week, doing some anaesthetic upskilling, catching up with friends & family at WOMAdelaide, then jetting off to Sydney to present a short piece at #SMACC2013. Bit daunting being in the company of gurus like Mike Cadogan, Scott Weingart, Cliff Reid, Casey Parker and Minh le Cong etc.

Meanwhile the KI Docs dispute is spilling out into the media. Hopefully some common-sense will prevail and the current status quo will be allowed to continue. Sadly I am learning that common-sense is not that common. Rather than retain local doctors’ services in A&E for 21 out of 28 days and 24/7/365 cover for both obstetric and anaesthetic rosters, it seems that the faceless bureaucrats at CountryHealthSA would prefer to sack the lot of us, pay locums bucket loads (going rate is reputedly $1700-2500 per day) and collapse anaesthetic and obstetric services on Kangaroo Island

Not good.

You can read more about the dispute here, here and here.

At the heart of the dispute is almost a philosophical question – whose responsibility is it to staff the roster for the State-owned public hospital? Whilst rural doctors have always fulfilled that role, the insistence that they are responsible for the entire roster even to the point of paying a locum to do the job does stick in the craw – on KI we have enough doctors to run our Clinic…but not enough to cover three rosters for each of A&E, Obs and Anaes…unless we work ourselves into the usual outcome of days gone past – early death, alcoholism, relationship breakdown, major depression and medical error.

So, here is a round up of media reports (to date) on the KI crisis – CLICK on the links to read associated news articles or media releases.


4 March 2013

Adelaide Now “Locum cut unhealthy for Kangaroo Island say GPs

See also the comments section – mostly supportive, although one Islander did wonder why the six local doctors could not work as hard as the 3 doctors 20 years or so ago. Fair comment and I would encourage such questions. Suffice it to say that the three doctors are no longer working on KI – one has left rural medicine entirely. When we talk to them, they cite the unbearable workload and not one wishes he had worked as hard. New doctors want to spend time with family, to relax…they still work a 40 hour week in the Clinic plus are on-call another 30-90 hours per week depending on the roster.

The Islander – “GPs in new hospital row

Leading with a photo from the dispute some years ago, The Islander will no doubt invite comments (both positive & negative) from readers.  Regardless of what you think of the Doctors, it is important to realise that this is happening and will affect delivery of services. The docs simply cannot work more than they are currently. 

ABC News “GPs upset as locum withdrawn

Sadly no ‘comments’ section, but hopefully local ABC will continue to repo this both on line and on radio.



KI doctors say the State Govt wants them to work dangerously long hours

“Doctors on Kangaroo Island say that the State Government wants them to work dangerously long hours because it won’t cover the cost of a locum.  The island’s six GPs work normal hours in a clinic and then provide around the clock services to the Emergency Department at the Kangaroo Island Hospital for 40 weeks a year.  Country Health SA employs a locum to staff the Emergency Department for one week a month to provide respite for the doctors, but that will stop at the end of this month.  Negotiations over a new arrangement for the island’s doctors have failed.  The doctors are hoping the Government will reverse its decision.

Local Kangaroo Island GP Mark Raines says doctors could compromise their standards of care by picking up their workload:

(891ABC 7.45am & 639ABC 7.45am/8.30am) “It’s about keeping the job sustainable and a position where we can provide a good quality service where we’re not sleep deprived and over-stressed and burnt out.”

(891ABC 9am & 639ABC 9am) “If somebody has been up all night dealing with a problem and then they have to go to work the next day to work in their general practice, or they get called back and they’re sleep deprived, then yeah I think it’s been well and truly shown in clinical studies that sleep deprivation leads to mistakes.”

KI GPs say a new workplace agreement will see them working dangerously long hours

Country Health SA has disputed claims by GPs on Kangaroo Island that a new workplace agreement will result in them working dangerously long hours.  From next month Country Health SA won’t be funding a part-time locum to staff the Emergency Department at Kangaroo Island’s hospital.  It means that the island’s six GPs, who already provide on-call Emergency Services most of the year, will have to pick up the locum’s workload.

Country Health SA’s Peter Chapman argues that standards of care won’t be compromised:

(891ABC 11am & 639ABC 11am) “If they did have to work significantly overnight and therefore were feeling ‘how can I do my clinic in the morning’, they are able to cancel that clinic in the morning so they can get their sleep et cetera and we make a payment for that.”

(891ABC 12noon) “Obviously for us to pay for them to cancel their clinic and reinvest in the morning is a very major initiative of the GP agreement so yes, we do understand very much the requirements of general practitioners.”

6 March 2013

Local MP Michael Pengilly has been working in the corridors of Parliament to raise the issue and issued a media release and was interviewed on 5AA with Leon Byner, transcript below.

Michael Pengilly, Member for Finniss   (5AA 12.12-12.15)   Reduction of locum support for Kangaroo Island GPs

(Byner: … the Weatherill Government’s inability to negotiate a sensible deal with local General Practitioners on Kangaroo Island … has threatened future health services … this Member of Parliament … is demanding that the Government disclose what arrangements are being put in place to install an adequate team of doctors into the local hospital on KI from March 31. Michael … what’s your understanding of what’s happened here?) … it’s like a long playing record that’s run off the track … I’ve been on this before, I’ve been on it again recently. What’s happened is that Country Health are trying to bulldoze the doctors into signing an agreement they don’t really want to sign. The current situation is that one week a month the locum comes in and takes the pressure off the local doctors to do the on call at the hospital but what they’re not doing is saying what arrangements they’re going to put in place after March 31st … it’s creating some major headaches on the island, I spoke briefly to the Minister about the matter yesterday … (Byner: …what did he say?) He wasn’t in a position to make too much comment but I’m sure that he’ll pick up on it. I just want to get a sensible outcome. I’m comfortable with contracts across the state but they have to have flexibility to work in localised areas and places like the island is indeed a localised area. (Byner: …so what’s the problem?) Well the Government don’t want to pay … (Byner: …pay for what?) … pay for the locums and what they’re also saying is that they want the local doctors to do the four weeks all the time … a month at a time. The doctors are saying well if someone’s on and then on Monday morning when they come off call, they could’ve been up all night, they could’ve been treating patients, then they have patients in the clinic to deal with – they’re just saying that it’s beyond them to do all that, they could make mistakes potentially, so they are saying that why bust up a good system that works well now – the community’s very anxious about it over there, they don’t want to have – Leon Byner might have an appointment for 11 o’clock on Monday and get there or get rung up and be told no the appointment’s off because the doctor simply can’t work …  it’s a common sense approach … my view is that the Weatherill Government’s got a self-inflicted budget crisis and  that should not become the Kangaroo Island community’s emergency and it just needs fixing and fixing properly. (Byner: …alright …we’ll take some interest in this because … you’re not allowed to drive a truck past certain hours of service because it’s not deemed that you’re a safe driver, well doctors are still human and surely the same laws apply to them.)


That is all for now. More updates as and when they occur.

Tackling the Health Bureaucracy

Government Bundles another GP agreement

There is a sense of “deja vu” today, as the Kangaroo Island doctors gear up for another tedious battle with the bureaucrats at Country Health SA.

You can read more in the media release below :

Media Release 4-3-13 KI Docs

The Island doctors have been told that the status quo (them providing 21 days out of 28 for the A&E on call roster … as well as complete 365 day cover for each of the anaesthetics & obstetrics rosters) is to come to an end on 1st April 2013.

The reason? Health bureaucrats demand that Island Doctors assume responsibility for the entire A&E roster, begging the question of ‘whose Hospital is it anyway‘? If they don’t, then the doctors will be removed from the A&E roster. Currently a locum does one week per month A&E on call, at a cost borne by the Health Department. To replace the local doctors will require a locum every day of the week – costing the Health Department even more. I’m no economist, but it seems an ‘interesting’ decision financially and one for which bureaucrats seem to be unaccountable.

Elsewhere in Australia, high fees paid to locums tend to drive out resident doctors, who also have to bear practice costs. There’s also a sense of deja vu – back in 2010 the Health Department replaced the Island doctors with locums – not only costing much, much more than the local doctors, but also leading to a significant drop in service (locums who could not plaster or insert an IV cannula were notable “fails”). One locum even fled after only a few hours, citing the ‘unbearable workload’.

So there you have it – local doctors no longer allowed to provide A&E services from 1st April 2013. The threat has been made by CHSA bureaucrats that anaesthetic and obstetric rosters will also be dissolved.

NOW is the time for the Kangaroo Island community to act if they want their doctors to remain able to treat them in A&E, deliver their babies or provide emergency & elective anaesthetics.

Hit the airwaves (891 Adelaide, fiveAA), write to the media (The Islander, The Advertiser), and tell the State Health Minister what you think.

Lack of accountability

Of course this is not the only problem the island doctors have had with Country Health SA. A colleague has described trying to deal with their bureaucracy as like ‘fighting candy floss’ – with meetings un-minuted, calls unanswered and a refusal to engage in meaningful or timely negotiations, it is very hard to get clear answers. There also appears to be a lack of institutional memory regarding previous decisions. We are not alone – the recently-departed Penola GP (who quit after being required to work a ludicrous 24:7 on call for over a year) has also hit out at the bungling Country Health SA bureaucracy.

Stand out gripes for recent times on KI include :

– failure to negotiate a new contract.

The previous expired in Nov 2011 and a ‘new’ contract was finally put to rural doctors in mid-2012. We are now in 2013…and rather than negotiate for a continuation of the status quo, CHSA have suggested the above

– failure to pay doctors under fee-for-service.

Of course I cannot discuss specific patient cases, but I can say that I am still chasing payment for in-patient services dating back to April last year. A common policy seems to be for the Hospital to call for a Doctor urgently to render assistance…then the urgency of that call to be disputed some months later by a pay clerk. Suffice it to say, call out fees differ if urgent vs non-urgent, the premium being to compensate urgency and impact on own clinic patients who have to wait. There is also a monthly battle over admitted vs non-admitted services – the former payable under fee-for-service, the latter charged as a private fee to the patient. Again CountryHealthSA seems to have a low threshold for calling the duty doctor – then arguing about payment later.

I am now owed thousands of dollars by CountryHealthSA over admitted patient fees. Sadly the agreed “dispute process” has lead to a series of unanswered emails and written demands for payment over months. Despite this I have kept on working at the Hospital, but it seems there is no accountability within the organisation to resolve this…

– the anaesthetic monitor fiasco.

Unbeknownst to any of the rural doctors (including the Country Health SA clinical lead for Anaesthetics), our existing monitors were replaced by new ones, reputedly costing $17,000 each. Estimates are that there has been over $500K spent across rural SA – despite the fact that these monitors were not needed (standards not mandatory) and replaced perfectly good existing equipment. This money spent even though we cannot get vital emergency equipment for our hospitals because “no money available’.

Jack Snelling is the Health Minister and perhaps should take note. The Health Dept needs to save $1 billion over five years. Perhaps some savings could be made within the bureaucracy?

So whilst all this hassle is going on, I am looking forward to a few weeks off and the chance to catch up with fellow #FOAMites at SMACC2013. Will be talking at 13:30 Tuesday 12/3/13 on ‘improving rural pre-hospital care in Australia’. Come along and heckle…


BASICS model for Oz?