Emergency room doctors and nurses in the Northern Territory town of Katherine could be overseen by a virtual specialist thousands of kilometres away, as a chronic shortfall in physicians continues to plague rural Australia.
- The NT government is looking for a virtual specialist to manage Katherine’s emergency room
- Tender documents say a shortfall in staff has compromised the hospital’s ability to care for patients
- The Rural Doctors Association says a specialist should be “on the ground”
Luring and retaining doctors to the isolated town, 300 kilometres south-east of Darwin, has long proven difficult, but the struggle has now reached new heights.
For the past five months, the town’s hospital — which services a regional population of around 19,000 people as well as thousands of interstate travellers — has been operating with just one director of emergency medicine.
According to a NT government tender, which is seeking a specialist fellow from the Australian College of Emergency Medicine for four shifts a week, the staffing shortfall has led to “ongoing critical roster gaps”.
“This compromises the hospital’s ability to meet patient demand and impedes the provision of appropriate quality, safe patient care,” the documents state.
The NT’s Health Minister says the virtual specialist will only act as an “additional support service”.
But the attempt to resolve the issue via a virtual director of the emergency room has been questioned by the Rural Doctors Association of Australia.
“A director role would be about day-to-day operational oversight [and] providing supervision,” its chief executive Peta Rutherford said.
“To do that remotely and not be … on the ground working as part of the team day to day, I struggle to find the value-add.”
Ms Rutherford said the plan would not resolve the hospital’s inability to meet patient demand.
“It would certainly not be an extra pair of hands on the ground should there be a multi-trauma that comes through the door.”
She said generalist doctors had been appointed to lead roles in emergency departments in other rural hospitals and the same could be done in Katherine.
“The reality is a director for a department really should be someone who is on site, able to oversee the day-to-day operations of the department, participate in the clinical governance and oversight and support all staff,” she said.
“I struggle to understand how that role could work in a virtual capacity … that person is no longer able to assist and provide direct clinical supervision.”
Dr John Bonning, a specialist emergency physician for more than 15 years and president of the Australasian College for Emergency Medicine, also raised concerns, saying he had never heard of a similar-sized hospital resorting to a virtual role.
He said it was likely that in a busy emergency room the virtual specialist would be required to provide patient care.
But he said assessments via a screen would not offer “hands-on care”.
“Often patients still need to be examined, which cannot happen virtually … if patients need resuscitation, if fractures need reduction, if they need IV lines placed for intravenous medications or antibiotics, that physical care cannot be provided.”
Hospital needs boots on the ground, doctor says
Dr Peter Spafford, who was forced to close the doors of Katherine’s only GP clinic four months ago, said the struggle to attract and retain doctors was a significant problem.
The closure of the GP clinic left the town without a service for about three months, and heavily reliant on an interim clinic and an after-hours telehealth phone line to a doctor.
Despite years of pushing the NT government to do more to help him retain doctors, Dr Spafford said isolation from family and friends, the extreme Top End climate and additional costs were too much to compete with.
“The problem is a lot of incentives apply to getting [doctors] to Katherine, but after a couple of years there are no incentives to stay,” he said.
“You can earn more money in the city than in the bush.”
Dr Spafford said while the NT government’s virtual solution was better than nothing, it was still insufficient.
“People will suffer … a critical emergency room needs hands on attention.”
Katherine resident Shirley Crane said concern was mounting, particularly among some senior citizens, that the town’s medical requirements were not being adequately prioritised by the government.
“Everything that happens here becomes part of the town’s reputation, and Katherine is fast moving to the top of the list people don’t want to move to.”
While she praised the care she has previously received at the hospital, she said she was “distinctly unhappy” about the prospect of the emergency room being overseen from across state lines.
“My son is a postie and if he was hit by a car and ended up in a critical, life-threatening accident, that would not be good,” she said.
“I wouldn’t feel confident at all.”
NT Minister for Health Natasha Fyles said while the virtual director would be able to provide clinical decision-making support and supervision for doctors, it was not intended to replace an emergency medicine specialist at the hospital.
“This service will provide clinical decision-making support as well as a peer support network for clinicians at Katherine Hospital Emergency Department to discuss cases and share information and knowledge,” she said.
“It would also provide additional support and supervision to junior doctors to provide quality, safe, emergency care.
“A telehealth model enables virtual face-to-face conversations and will allow for discussions about clinical decision making to occur at any time.”