The rundown state of rural hospitals represents a "major" risk to both doctors and patients, a survey of their managers has found.
Taken last year by the New Zealand Institute of Rural Health (NZIRH), the survey said all rural hospital managers who took part felt there was a shortage of qualified medical staff, with two-thirds rating as either serious or critical.
Buller Hospital had had gone through 170 doctors between 2001 and 2009, New Zealand Doctor magazine reported in a story on the survey.
But Buller Hospital was not alone in having difficulties, with the survey showing hospitals were struggling to fill their allocated positions - with 80.9 fulltime positions for general medical staff budgeted for, but only 53.9 employed, meaning 33 percent of positions were either not filled or covered by locums.
To make matters worse, 92 percent of managers said there was a lack of locum staff, with just over half rating the shortage serious or critical.
The survey highlighted the pressures rural hospitals faced, NZIRH chief executive and survey co-author Robin Steed said.
These pressures created a "less than ideal situation for both the health professional and the patient", she said.
Professor Ross Lawrenson from Waikato Clinical School, who helped prepare the survey, agreed, telling a conference of rural general practitioners the situation represented a "major" risk to both patients and doctors.
"There are a significant proportion of hospitals that have no recognised medical leadership, do not appear to credential their medical staff and have no formal clinical governance structures," Mr Lawrensonn said in a presentation to the New Zealand Rural Practice Network this year.
"[The survey] represents a major risk to the organisations and to their patients especially given the large proportion of generally/provisionally registered medical practitioners and the wide use of locum staff."
Another finding was that only 53 percent of rural hospitals credential their doctors, which was not ideal, Ms Steed said.
Credentialing is the process by which doctors receive authorisation to work in different areas of medicine.
Lack of credentialing meant doctors could not be completely sure they were permitted to carry out specific operations and procedures so hospitals were unsure whether a patient should be moved to a larger hospital, she said.
The survey also found 36 percent of rural hospitals had no designated medical leader and, of those that did, only one had a specialist in the position.
The situation was not all bad with recent developments in the training of rural doctors positive steps which would help make rural medicine a more viable pathway, Ms Steed said.
Gore Health chief executive Karl Metzler said all rural hospitals struggled to attract and retain staff.
"[Gore Hospital] are probably one doctor down and, because we only have a staff of five doctors at any one time, one down makes a significant impact," he said
Being short on staff inevitably affected on the standard of care, he said.
"You would like to think it doesn't, but it inevitably will, because people will wait longer to be seen, just because there is not the capacity there."
Former West Coast District Health Board chief executive Kevin Hague, now a Green Party MP, said New Zealand "is facing a crisis point for rural hospitals".
Too many doctors were becoming specialists, which had resulted in a lack of staff who could cover a wide range of areas as was required by a rural hospital.
If the specialisation trend continued, rural hospitals would be forced to close, he said.
While there was some progress, such as specialised rural training being introduced, it was not happening fast enough, Mr Hague said.
From his experience at West Coast DHB it was always difficult retaining and finding new staff.
"Retention and recruitment are the big problems because you tend get either a virtuous cycle or a vicious cycle," he said.
"So if you have a department that's well staffed, that is an easier department to recruit to, but on the other had if a couple leave then you are recruiting someone into a situation that feels less stable."
This made it harder and harder to full vacancies, he said.
Of the survey, Mr Hague said in his view some of the "hospitals" included - such as Buller - were not in fact hospitals but secondary medical centres staffed by GPs.
Rural Women New Zealand health spokesperson Anne Finney told NZPA the situation in rural hospitals often meant long waiting times and long drives to hospitals in larger cities.
"We are definitely concerned about the way in which waiting lists for rural people are getting longer," she said
She said a reason for the shortage in staff could be because young graduates were generally from urban centres and may not want to move to small rural towns.
NZPA
source: newshub archive
