GP obstetricians increasingly shut out of hospitals

Doug Hendrie

12/11/2018 3:30:11 PM

GP obstetrician Dr Nooshin Rasool will no longer be able to deliver her patients’ babies in hospital – and she is not alone.

Dr Nooshin Rasool loves the fact GP obstetricians are able to work with patients from before they are pregnant through to delivery.
Dr Nooshin Rasool loves the fact GP obstetricians are able to work with patients from before they are pregnant through to delivery.

Dr Nooshin Rasool always wanted to be a GP obstetrician.
Her father, Essa, has been a GP obstetrician for decades, working across rural Western Australia before moving to Rockingham in the outer suburbs of Perth.
When Dr Rasool became a GP obstetrician, she started working alongside her father.  
‘I always wanted to be a doctor and I liked what my dad did. I could see it was important. So I followed in his footsteps,’ she told newsGP.
‘I love being able to develop a bond with patients. The continuity of care is what drew me to general practice. I like seeing pregnant women, following them on their journey.
‘I see women in my clinic while they are pregnant, follow them all the way to birth and be present for that, then see them on the ward, then back in the clinic after that and follow them for years till the next pregnancy. That was the ideal model.’
That model, however, is changing.
Dr Rasool has worked at Rockingham General Hospital since 2014, where she delivers the babies of women for whom she has cared as part of a shared care agreement.
Rockingham has long had many of its babies delivered by GP obstetricians. But, as of next year, Dr Rasool won’t be able to participate in deliveries anymore.
As part of a changing model of care, the hospital required its seven GP obstetricians to apply for a new job working alongside midwives. Only one GP obstetrician got a position.
‘We understand the model of care had to change to accommodate increasing needs and complexity of the community,’ Dr Rasool said.
‘As GP obstetricians, we’re very keen work alongside other models of care. What we’re requesting is just to keep us involved in intrapartum care.
‘I don’t understand why GP obstetricians had to be excluded, almost entirely.’
Dr Rasool said part of the issue is that hospital managers often do not necessarily understand the antenatal and postnatal care GPs are delivering in the community.
Kath Smith, executive director of the Rockingham Peel Group, told The West Australian the new model would use a salaried medical workforce and offer midwifery-led care.
‘This contemporary and evidence-based model of care is already in practice in hospitals throughout WA and Australia and is not intended to replace any antenatal care in the community currently provided by GP obstetricians,’ she said.
The RACGP recently raised the alarm over the Australia-wide trend of hospitals turning away from GP obstetricians.  
Dr Wendy Burton, Chair of the RACGP Specific Interests Antenatal and Postnatal Care network, said GP obstetricians are being increasingly shut out.
‘I am hearing from GPs around the nation that they are being pushed out of providing care to women who they have an existing therapeutic relationship with, in exchange for hospital-based care which typically concludes six weeks or less following birth,’ she said.
‘Many women do not even know that their GP, in partnership with midwives and obstetricians, can play a key role in their antenatal care. We need to get better at closing the gaps in care that occur as women transition between specialists or hospital-based and community-based care.’
The college has warned the trend risks reducing choices for pregnant women.
If the situation continues longer term, rural and remote maternity care may be at risk. GP obstetricians provide the majority of antenatal and postnatal care outside of Australia’s major cities.
Dr Rasool said if GP obstetricians cannot work in major hospitals, they will not be able to keep their training up to date.
‘You can still provide antenatal shared care, but this takes away intrapartum care. That procedural [knowledge] is really important if you’re going to be the main provider in rural and remote Western Australia,’ she said.
‘Not being able to work in hospitals has implications for GP obstetricians for the whole state. We provide the backbone of maternity services in rural and remote areas, and we need to be able to upskill and get training in metropolitan areas.
‘GP obstetricians offer the ultimate continuity of care. Our relationship with patients often predates the pregnancy and can go for decades afterwards. That’s something a hospital can’t rival, and we know continuity of care is associated with good health outcomes.’
The RACGP will be calling on the government to value the role of GP obstetricians in the new National Strategic Approach to Maternity Services (NSAMS), due for release next year.

The RACGP’s ‘Maternity care in general practice’ position statement is available on the college website.

GP obstetrician hospitals maternity care western australia

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Gan Sakarapani   13/11/2018 8:57:42 AM

This is nothing new and the writing has always been on the wall. The same fate is destined for GP Anaesthetists as well. Its a turf war. Too many specialists, not enough jobs and suddenly procedural GPs are not good enough or dont fit the model of care.

The last bastion for procedural GPs is rural medicine. There are still good opportunities available but not for long. Get out of your metro comfort zones and secure your rewarding rural future whilst you can. It wont be long before the tsunami of new graduates will make it very difficult for procedural GPs to secure any kind of meaningful work.

I made the change 10 years ago and have never looked back.

Marc Heyning   13/11/2018 2:23:06 PM

I agree with the author - the ultimate continuity of care that can be offered by a procedural GP Obstetrician can not be equalled by any hospital based midwifery or specialist model. It sounds like Kath Smith is just accepting the evidence that caseload midwifery care model (my assumption on proposed new model of care) is the best model of care. However, the studies were done against traditional models of labour ward/birthing unit staffing models - not against procedural GP Obstetrician/case-load midwifery collaborative care model. The losers are the women - their care with the hospital based midwives finishes at 4-6 weeks post partum and their ongoing care is from their GP whom knows nothing first hand of the journey this woman has travelled. (PS I am a procedural GP working hard to continue to convince our local health service that we have a relevance that those in ivory towers cannot see)

Dr Evan Wayne Ackermann   14/11/2018 8:11:01 AM

The reason why GP obstetricians "had to be excluded" is to cement the role of midwifery care in obstetrics. This has been a long term outcome for the Nursing profession over many years. "Collaboration" was used when it really meant "role substitution".
Marc is correct - Midwifery misrepresented the evidence regarding midwifery models of care. They marketed themselves extensively along the lines of "a natural birth" - to the detriment of the safety of women and their babies. The health managers fell in line because of perceived "costs benefit"
Unless we see these big pictures, the model will be repeated.

Mohammed Hussain   14/11/2018 10:17:55 AM

Sorry to see that happening to you all. I used to be a SMO in ED for some years but with the coming of FACEM,s and my refusal to do rural fellowship, I was forced to leave the hospital system.politics and $$$.

Tim Linton   26/11/2018 5:42:05 PM

Sad to hear that. I'm working as a GP Obstetrician in Gove, NT in a very happy and well run ward. We need more GP Obstetricians and would love to hear from anyone looking for a location change! In my view, the model of care here is great, and a good example of cooperation between doctors and midwives.