Obstetricians - Future uncertain

A survey in 2001, conducted by Professor Alastair MacLennan and Mr Michael Spencer of the Department of Obstetrics and Gynaecology at the University of Adelaide, assessed how long Australia's specialist obstetricians intend to continue practising and their reasons for abandoning the specialty.

In the survey, Australian specialists holding a Fellowship of the RANZCOG cited the following main reasons for ceasing obstetrics:

Intention to specialise in gynaecology;

Fear or trauma of litigation;

High indemnity insurance costs;

Family disruption; and

Long working hours.

Of the 826 respondents to the survey, about two-thirds had experienced the threat of litigation, and almost all desired some type of "no-fault" indemnity scheme.

"The cessation of obstetric practice has previously been particularly high among general practitioners and rural specialists", says Professor MacLennan.

"The rapidly escalating cost of medical indemnity insurance has become a major precipitating factor. In 1980, indemnity for specialist obstetrics and gynaecology could be obtained for $100. In 2001, the base rate for indemnity offered by Australia's largest indemnity provider, United Medical Protection, ranged from $20,970 in the Northern Territory to $54,315 in New South Wales."

"In a 2001 survey, 24% of 109 new Fellows and Members in their final two years of training stated that they did not intend to perform any obstetric work," says Professor MacLennan.

The survey reveals an aging obstetric workforce, with a shortfall in the number of practitioners available to replace those planning to retire over the next 10 years.

Professor MacLennan warned that rates of retirement from obstetrics may rise even further if an increasing workload falls to those still practising obstetrics and if indemnity premiums continue to rise.

"There is likely to be regional variation, with higher retirement rates in New South Wales, where indemnity costs are highest."

"Most obstetricians are self-employed, work in private practice and must pay their own premiums," Professor MacLennan said.

Premiums vary from State to State, and much higher premiums have been foreshadowed for 2002-03. The base rate in New South Wales will be $97,412 in addition to a call.

Professor MacLennan said many obstetricians expressed a preference for a publicly funded compensation scheme for all adverse medical events and conditions, along the lines of the New Zealand government's accident compensation scheme. However, such a scheme might increase the number of claims and, unless compensation was capped, could prove expensive.

The authors say that until long-term solutions have been discussed and enacted, there will be increased transfer of pregnant women from rural areas to city hospitals, and it will be necessary to find more obstetricians from abroad.

"In the near future, a reduction in the quality and quantity of obstetric services appears almost inevitable," says Professor MacLennan.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACT: Professor Alastair MacLennan

(08) 8161 7000 (B/H)

(08) 8338 1419 (A/H)

Mr Michael Spencer

(08) 8212 1077 (B/H)

Sarah Crichton, AMA

(0419) 44 0076