Regional healthcare workers are reaching “breaking point” as state border restrictions make filling roles outside city hubs nearly impossible.
Australia’s regional health force is highly transient, with many hospitals relying on interstate locum workforces and “fly-in fly-out” doctors who live in capitals cities and often travel interstate for work.
The lack of ability to access interstate workers has already caused one Tasmanian hospital to drastically cut back its operating hours.
Last week the Tasmanian Department of Health announced that the Mersey Community hospital in Devonport would now only operate its emergency department between 8am and 6pm, Monday to Friday. This was the second reduction of hours to the hospital’s ED during the pandemic.
The state’s health minister, Sarah Courtney, said it would be unsafe to run the department understaffed.
“In order to ensure high-quality care for our patients, it is imperative that we only provide services in situations where appropriate staff levels are available,” she said.
“The majority of locums who staff the [Mersey Community hospital’s] emergency department are from interstate. Due to current quarantine requirements and travel restrictions, finding locums to be able to staff the emergency department has become extremely difficult.”
Courtney acknowledged the decision would “likely cause some anxiety within the local community”. Those requiring emergency medical attention will be diverted to hospitals in neighbouring towns.
The Rural Doctor’s Association of Australia head, Dr John Hall, said the combined pressure of Covid-19 and snap border closures had placed regional doctors and nurses under “unsustainable pressure.”
“If you are a GP obstetrician in a remote area and just want a weekend to yourself, the chances of you finding a locum to travel all that way to cover you for your short break is about as remote as the location itself,” Hall said.
In many cases, relief doctors would be required to isolate for two weeks in order to do several days work across a state border.
“The longer the pandemic goes on, the bigger the problem will become,” Hall said.
After a devastating fire season and six months of pandemic response, Hall said fatigue in regional healthcare workers was starting to set in.
“For months now these doctors and nurses have been pulling extra shifts and been on-call at nights and weekends over long periods of time,” he said.
“Most rural doctors have just increased their workload, or continued on throughout without taking a break, however, these demands are starting to take a toll … mental and physical fatigue is a growing concern, especially in the high-pressure environment created by Covid risk.”
The president of the Australian College of Rural and Remote Medicine, Dr Ewen McPhee, said many remote doctors had also been isolated from family.
“Some of them haven’t seen family members for many months, especially in extremely remote communities where there is a lot of concern about ‘fly-in fly-out’ doctors,” he said.
“There are some serious pastoral care issues.”
Border closures have also caused problems for hospitals operating in larger communities close to state lines such as the regional city of Albury-Wodonga between NSW and Victoria. Originally it appeared doctors and nurses outside the border bubble might not be able to travel across the river to work.
The chief executive of the Rural Doctor’s Association, Peta Rutherford, said while problems between Victoria and NSW health services were resolved, the same problem had sprung up when Queensland shut its southern border.
“We understand that decisions have to be made quickly, but I don’t think we are learning as we go,” she said.
“We’ve particularly heard about specialists outside the border bubble in Queensland. They might be from the Gold Coast and travelled regularly down to Lismore to work. They can come down for work, but basically they can’t go home unless they self-quarantine, at their own expense, for 14 days.”
McPhee said many regional areas were also reliant on the estimated 5,000 international doctors that conduct placements around the country each year.
“Substantially those doctors are there to provide locum support on the ground as specialists and GPs in regional Australia. We always seem to have a strong reliance on international doctors to provide for the country people but with the heavy Covid-19 travel restrictions that is looking very fraught,” he said.
He said it was imperative that state government resolve border issues relating to healthcare in order to make up for the international deficit.
“I think we need to sort out the state borders issues and have some consistency around professional travel and health travel. [We need] the different states aligning with each other to have some sort of agreed process,” he said.
“The other aspect of this is that there is meant to be a national medical workforce plan being developed, but with Covid that work … has been delayed. We certainly need to see that work reinvigorated.”