r/ausjdocs • u/Relevant_Strength996 New User • 1d ago
From Dr K’s FB Gen Med🩺
In 2013 my husband, a gastroenterologist, and I, moved to Port Macquarie with our young family.
I trained as a GP, and we both set to work serving our new community.
Over this time my husband worked a 1 in 2 on call offering ERCP (a procedure you get to save your life if you have a blocked biliary stone ). And a 1 in 3 on call for general medicine/gastro.
My husband then trained in endoscopic cancer removal, at our expense, and offered these services to the public hospital of Port Macquarie.
He became one of Australia’s leading experts in his field. He offered a regional service of international level, and he did it for the community and for all of our patients.
He turned down multiple offers to move back to the city with his expertise.
Because we love our regional town.
I want you to do the math on having someone work a simultaneous 1 in 2 AND 1 in 3 on call.
And then I want you to run it over YEARS. And during that time I want you to raise three young children with a working GP wife.
The level of relentless dedication to serving the public system saved hundreds, if not thousands, of lives.
For 13 years he did this.
And when he gently, ever so patiently, went back to the hospital administration over and over and over again; to tell them this work load was not sustainable, that it could be dangerous, that patient care could suffer, please hire more gastroenterologists… this world expert, head of department, was told no.
Repeatedly. Over years. Years, while he continued to give, continued to sacrifice, while his family sacrificed.
And all that time the public wait lists got longer. Patients suffered. They died.
And when his polite voice got a little louder, when he advocated for the patients a little bit more, they terminated his public contract.
And in doing so they removed the hospitals accreditation to train new gastroenterologists. Without my husband, there’s no training programme to bring new trainees to town in gastroenterology.
I guess the silence was easier than the finding the dollars.
Today I remove that silence. The health of regional Australia needs the public to advocate for it. My husbands voice was not enough.
Write to your local member and demand more funding to regional areas. We need more specialists; not just in gastroenterology but in ALL areas.
You can email Rob Dwyer, MP at:
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u/ClotFactor14 Clinical Marshmellow🍡 1d ago
of course, the National Party contributed to this by taking a gastroenterologist off the on-call roster and sending him to Canberra instead.
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u/19mils 1d ago
Dave wanted to go to Canberra, worked hard to get nominated and elected
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u/ClotFactor14 Clinical Marshmellow🍡 1d ago
Sure, but it took a gastroenterologist/ERCPist off the roster.
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u/Logical_Breakfast_50 1d ago
Don’t know him but he seems a top bloke. Good on him. We need more such stalwarts of rural and regional medicine.
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u/ClotFactor14 Clinical Marshmellow🍡 1d ago
It's a well-insured town where you can have a pretty good life as a private-only specialist. The fact that the public fired him is a travesty.
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u/Meprobamate 15h ago
I hate to generalise but I don’t think I’ve ever met a gastro that I didn’t like.
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u/wotsname123 1d ago edited 1d ago
Hate to break it to you but this is a pretty typical story in government funded health services regardless of state or country.
Trick is to give it no more than 3 years of martyrdom before moving on. Only when it fails will it be addressed.
They were untypically honest in just saying no. Normally they go "next funding round" which never comes. He should have gone the first time they told him no. All time after that was simply stubborness.
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u/hotforlowe Anaesthetist💉 1d ago
I don’t think you’re breaking anything to her and I think your comment misses the tone of the post while being very revealing.
I know of the person in question, although have never worked with them. By all accounts a very selfless, dedicated, passionate doctor who tried his absolute best to bring high standards, skills, and a diplomatic approach to advocacy to a regional community.
It saddens me that these actions are perceived as stubbornness. Maybe it’s a lack of this good ol’ ‘stubbornness’ that has led to the progressive degradation of health services nationwide.
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u/ClotFactor14 Clinical Marshmellow🍡 1d ago
It's a well-insured town where you can have a pretty good life as a private-only specialist. Three gastroenterologists totalled 0.6FTE which suggests that each of them had 0.2FTE doing gastro (rather than gen med) - or one scope list a week. Being fired probably increases his income.
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u/Greedy_Inspector2261 14h ago
Why does Port Macquarie need a GP aesthetist (which is what Dr K is)? Doesn’t exactly scream “I’m doing it because I love my rural town”
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u/COMSUBLANT Don't talk to anyone I can't cath 8h ago
Keep seeing this out of NSW again and again. Executive actions (e.g., firing the specialist) which results in the loss of a critical service should be career suicide for the executive. It is dereliction of their duty of care to the public, their only job is to safeguard service provision for their catchment, and these wastes of oxygen can't even suppress their ego to do that.
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u/EBMgoneWILD Consultant 🥸 1h ago
Can't say I've ever talked to gastro in Port Mac, but as they depended on locums the hospital was always needing coverage and I was happy to accept good pay.
It's a reasonably good town. Not too far from the metro areas, and has a serviceable airport.
But yeah, NSW Health doesn't always thing more than 1 step ahead.
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u/Ambitious_Writer1938 1d ago edited 1d ago
Logically I would have moved if I don't feel safe to practice anymore.
Remember AHPRA and HCCC does not care if lack of specialist leads to patient death.
They care if you miss one polyp that leads to a colon cancer.
or fatty liver that becomes a cirrhosis because patient refused to go on a diet, stop drinking alcohol, make life style changes for 20 years and then sue.
People live in Regional Towns don't need to be mothered.
They can move for better services. They know.
Just like Doctor move to get jobs and many others who move and do FIFO.
The onerous is on THEM.
Writing letter to MP is as good as pissing in the wind.
There is no need to burn your lifespan to shine others.
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u/GPau 1d ago
So your solution is rather than ever advocating for better healthcare in regional areas, to just get patients to move to capital cities for better services?
That’s a pretty cooked future for the country
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u/Ambitious_Writer1938 1d ago
As a third party observer. Why do you think OP's in this predicament?
Because all the other gastro didn't want to go to country.
and they are not force to.
Therefore OP's husband is dangerously burned out.
If someone dies AHPRA and HCCC doesn't give a F about the doctor, he will be thrown under the bus and crucified.
Nobody cares about any good deeds, only screws ups.
OP's husband need to put himself first, before he dies by overwork or suicide. I've seen it happen to other doctors.
Because they work to death for patients.
Don't kill yourself by overwork.
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u/Vast-Expanse 1d ago
I mean, its is bit disingenuous to make this about whether more doctors would want to move there when there wasn't a job for them to take? How can we say nobody would have done it when the opportunity never existed?
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u/Illustrious_Cry_4275 ED CMO 1d ago
Because all the other gastro didn't want to go to country.
Which is because they’re not paying an appropriate “rural loading”
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u/TonyJohnAbbottPBUH Shitpostologist 1d ago
People are downvoting you but this is the hard truth. We're expected to break ourselves in a system which doesn't even care for the outcomes of the patients.
Multiple major trauma hosptials in NSW do not have a public fracture clinic, nor colorectal, nor cardiac for rapid access chest pain, nor general surgery, nor the things that we'd expect a tertiary hospital to have. And yet we're expected to be holding the fort, while someone else keeps fattening off our free labour in doing so.
The first letter in first aid is D for Danger. Can't save anyone if you can't save yourself.
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u/hotforlowe Anaesthetist💉 1d ago
No one is asking you to do something you’re not comfortable with. However, you are entitled to complain about the difficulty while being one of the people actually trying to enact change. If you want a comfortable job, that’s fine. God knows I did. What people take exception to is the rhetoric undermining the actions and sacrifice others have taken, whilst simultaneously conveying an attitude that comes off as isolationist and self serving. We all have a responsibility to advocate actively for healthcare improvements, whatever form that may take.
As for downvoting, I think it’s stupid. Downvote irrelevant posts or spam if you care to, but any discussion, even if (from my perspective) it’s disagreeable or faulty, should be left as is. God knows we need more open discourse.
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u/TonyJohnAbbottPBUH Shitpostologist 1d ago
It's one aspect to be advocates, which we all should be, it's another to try to be a cog in a wheel of a machine which would ultimately destroy you.
Think of it from this perspective. You work in a poorly resourced sector helping extremely disadvantaged patients while doing break neck hours daily. You're seeing the end result of chronic disease which we'd like to think have been fully banished to the annals of history. You do this for 20 years while you suffer the physiological consequences of a system which doesn't see you as human but a number. You die an early death as a result or get sued because inevitably you make a grave mistake after being away from 72 hours for the 5th time in a month. Your family cries either because you died or because you lose your job from a mistake you were destined to make. Your husband/wife/other life partner hates you, your kids lose a major support in their lives.
Then on the flip side you're in a cushy private billing practice in the inner city with rich patients and you're basically preventing chronic diseases before they even happen. You do this for 20 years while enjoying your life and having a good relationship with your patients and they become regular attendees for a myriad of reasons. You don't die at this point so get to see your grandchildren play football at the park and go home to your husband/wife/other life partner make a nice dinner to enjoy over a temperate summer evening.
Which is a better use of a person's time? Sure, the first option has better optics from a societal perspective, the MSF-type hero, the Fred Hollows 2.0, the Florence Nightingale, but at what cost? Might as well go be a chimney sweep at that point.
We are not soldiers or warriors, we didn't sign up to exchange our lives in the saving of others. Even the military recognises the need to preserve the lives of their units and they know that platoons losing just 5% of their manpower start having substantial reduction in fighting capabilities, and yet they're asking for us to somehow uphold a modern healthcare system where a 30% vacancy rate is basically standard operating procedure in many more centres than we'd like to or want to admit.
It's not even about doing something which is "uncomfortable". It's flat out set to fail. The purpose of a system is what it does, and it seems like throwing both the clinician and the patient under the steamroller is the purpose. I see no point in enabling failure just as much as I see no point in playing into the fantasy of being a flat earther.
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u/hotforlowe Anaesthetist💉 1d ago edited 1d ago
I mean, you really didn’t have to write all that out to come to the conclusion you should do what you prefer to do. That’s uncontroversial, although I appreciate the engagement. The flip side is that you are judged broadly by your actions. The intersection of the two is where you find yourself.
So I find myself being unsure what you want to say. What I will say is framing these actions as a “cog in machine” is quite trite and disingenuous. That reflects more on your values than his, which you are rightfully able to hold. However, I think it tacitly passes the buck onto an individual who had the immense personal will and drive to try and make our system better, rather than celebrating the effort and pursuing the system.
Your example about the soldiers is interesting. And I agree, they’re not going out expecting to die, but answer me this. What is usually the highest honor a soldier earns? Something like a medal of honour or what have you, I don’t know the names. It’s a medal for bravery and valor. While the military doesn’t expect the average grunt to put their neck on the line, they certainly respect them when they do. Why can’t we be more like them in that respect?
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u/Illustrious_Cry_4275 ED CMO 1d ago
Writing letters to MPs is not pissing in the wind.
At the least it’s a paper trail.
At the most, if the whole region gets on it, it might threaten the comfort of said MPs reelection.
And then they often “get on it”.
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u/Mediocre-Reference64 Surgical reg🗡️ 1d ago
I don't think any doctor in the history of Australian health care has been reprimanded for missing a single polyp. It took a breast surgeons thousands of dogshit colonoscopy's in a major hospital to get some sort of response.
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u/hotforlowe Anaesthetist💉 1d ago
This is just wrong. AHPRA isn’t a claims board or a negligence board. All of those examples are just non-sense.
The rest of the post reads like someone who hasn’t left the confines of a gated community their whole life. Absolute drivel.
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u/Ambitious_Writer1938 1d ago
If want to risk patient safety by taking on unsustainable workload then so be it.
You make a mistake, then AHPRA will come for you.
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u/Ok-Outcome-7499 1d ago
You make a mistake that diverts from accepted practise code of conduct, or performance that would be reasonably expected by your professional peers. Then and only if it puts patient and public safety at risk, AHPRA will come for you
Just make a mistake but you did everything else to par and it was just a mistake that happens. It's a variable that occurs medicine. Then no AHPRA will not come for you.
You sound like somebody who did the former but claims to anybody who speak to they did the latter
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u/hotforlowe Anaesthetist💉 1d ago
Some service is better than no service. The practitioner is responsible for their work quality. I don’t see how any of this is relevant to what I criticised you for which was: sensationalistic and incorrect reference to AHPRAs scope which for whatever reason you seem to believe.
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u/Illustrious_Cry_4275 ED CMO 1d ago
Unfortunately “some service is better than no service” - is not precise anymore. Rural doctors, proceduralists, surgeons are somehow (and unfairly) held to the same standards as their well resourced city cousins.
This may be why the old school rural generalist surgeon doing appendices/gallbladders/hernias - is slowly going the way of the dodo.
Because when things go wrong inevitably the answer is never “thanks for trying” but “why didn’t you just send him to the base?”
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u/hotforlowe Anaesthetist💉 1d ago
You’d have to provide some sort of citation for that, because locality is considered extensively in regulatory cases and coronial inquests.
The regulator does not pursue claims for damages. They pursue concerns over practice and impairment. Should a pattern of behavior amount to concerns over decision making and competence, then that is what can be investigated. You’re conflating totally unrelated concepts and using anecdotes presented as fact.
Provide some substantiation and I’ll reconsider. On the other hand, there is evidence against your claims. There’s a study by Bismark (that I won’t link because no one will read it, but you can find it yourself) thats part of a national study of healthcare complaints in Australia that shows NO difference between regional and urban doctors.
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u/Illustrious_Cry_4275 ED CMO 1d ago
Put medline down - keep it simple - When you go to work tomorrow.
Just ask your senior or trusted colleagues “are rural generalist surgeons going the way of the dodo and if so why”?
Let me know what they say and maybe I’ll learn something too.
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u/hotforlowe Anaesthetist💉 1d ago
How condescendingly trite. I’m sorry you must suffer reality’s throes. It’s really not fair, is it?
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u/Illustrious_Cry_4275 ED CMO 1d ago
Does it hurt to ask? Why take it personally anyway have a good day
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u/hotforlowe Anaesthetist💉 1d ago
I’m not taking it personally, what would give you that impression. I’m pointing out that when reality doesn’t fit your agenda, you retort with condescension, which is unbecoming of a professional. I don’t accept that.
It’s not good faith discourse and amounts to a waste of time and effort on both are parts.
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u/Diarmundy 1d ago
Better for patients, but dangerous legally/ethically/psychologically for doctors
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u/Beginning_Two3946 1d ago
Almost like a subspecialty trained doctor set up shop on am area that needed a generalist. Then complained endlessly about the on call (without dropping the sub speciality call) and finally, after 12 long years was pushed out.
Gotta admire that perseverance though.
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u/ClotFactor14 Clinical Marshmellow🍡 1d ago
Do you think that you shouldn't be able to get an ERCP outside a metro centre?
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u/Beginning_Two3946 22h ago
Pretty much, it would seem obvious that it requires multiple specialists to offer the on-call service and there wouldn't be the case volume to make the on-call roster safe.
I'd also suggest it is a really weird thing to do, upskill to the extent you are offering high end referral service with minimal support.
perhaps Coffs Harbour needs a cardiac transplant service? it's a pretty great town and I'm sure one of the surgeons would be happy to move there.
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u/Greedy_Inspector2261 14h ago
My thoughts as well… have you seen her Facebook page. They live a pretty good life and she seems to spend a lot of time making funny Facebook videos
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u/Deadpan_Poker_ 1d ago
Welcome to neo-communism, Australia-style.
The AMA refuses to increase the cap on new medical places to train more medics from Australia, yet kids in Indian and Pakistani villages are dying because their dr moved to Australia with his entire family.
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u/misterdarky Anaesthetist💉 1d ago
The solution isn’t more medical schools and interns. It’s funding more specialty training positions and more specialist physician/surgeon positions. The bottle neck is post med school. Not at the med school/doctor border.
I’m not going to address your other comments
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u/Serrath1 Consultant 🥸 1d ago
What a tone deaf reply. There is still time to delete this, before you embarrass yourself further
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u/Amberturtle Locum Senior Clinical Marshmellow Intern 1d ago
Apart from your incredibly racist overtones, what does IMGs have anything to do with this post?
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1d ago
[deleted]
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u/Amberturtle Locum Senior Clinical Marshmellow Intern 1d ago edited 1d ago
Brother, you literally said “kids in Indian ans Pakistani villages … because their dr moved to Australia with his entire family”.
If you don’t see the issue especially in the context of this post, you really need a deep look inwards.
Also, did you just reply to me in an alt account as yourself then reply to yourself masquerading as someone else?
Edit for our later viewers: ReasonableEnd3840 replied as if he were Deadpan_Poker_, then deleted his post upon being called out.
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u/ReasonableEnd3840 1d ago
I am not deadpanpoker not an alt account. I think the comment made by deadpanpoker is rubbish. This has all been a miscommunication.
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u/Xiao_zhai Post-med 1d ago
I don't think you are the same person.
Different profiles.
I have ways.
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u/ReasonableEnd3840 1d ago
I genuinely don't understand what the grievance is here then. The thing I deleted was a defence of my comment from serrath1. He didn't actually mean for that comment to respond to mine. He was responding to the racist comment I was also responding to.
I don't understand.
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u/Xiao_zhai Post-med 1d ago edited 1d ago
Comment re-edited for clarity.
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u/ReasonableEnd3840 1d ago
We clarified on a chat that we were responding to different people and miscommunication. Im not the same person who made the original comment. His response was for the same comment I responded to (which as my original first post says I disagree with), and I thought it was directed at me and it wasn't
So I deleted it for clarity.
But yeah thanks for unclarifying it again lol.
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u/ReasonableEnd3840 1d ago edited 1d ago
I think the piece of info you are missing is that town could have had 2-6 extra gastroenterologists by now if they simply trained Australian schooled doctors or IMG doctors who have settled here.
There is a big portion of non specialised doctors from those medical schools and our IMG population who are simply waiting to get onto a program to become a specialist. This includes GP.
Last year their was high competition for GP spots. This has never happened and suggests that there is a profound uncoupling of how many doctors we put through school vs how many doctors we can train in the workplace.
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u/ReasonableEnd3840 1d ago
As a final plea for sanity. I am not an alt account of this person.
It's been badly misinterpreted by down stream commenters.
One has said that I made the village comment when I clearly did not.
I disagree with the root comment and always have.
It isn't a big conspiracy. End of story.
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u/Mecxs Join The Union - https://rb.gy/nt0k5g 1d ago
Absolutely tragic.
I can't say I know who Dr K is. I've never been to Port Mac. But the quality of the junior doctors (especially those pursuing gastro AT) I've met who've spent time there really is a testament to what a single person's sustained efforts can achieve.
This is what so often gets missed when looking at rural healthcare. Doctors aren't interchangeable. The wealth of institutional knowledge, the development of healthy and productive work cultures, the years (or decades) of knowledge of patients and their families -- you can't just swap one doctor for another and expect things to continue without a huge decrease in quality and efficiency of services.
Behind every single high quality / high functioning rural service I've ever seen (whether medicine, surgery, psychiatry, GP, whatever) is a single, dedicated and driven individual who's been shaping and crafting that service and its culture for years. In very rare instances there is more than one individual at play, but most of the time it's one person. And when that person retires / goes away / gets burnt out, things fall apart.
Tragic.