The eHealth readiness of Australia's medical specialists - Final Report

Obstetrics, gynaecology and neonatology

Page last updated: 30 May 2011

General overview

Description of specialtyObstetrics and gynaecology are the surgical specialties concerned with the female reproductive organs and pregnancy, and as such are combined to form a single medical specialty and postgraduate training program. Specialists in obstetrics and gynaecology may practice as obstetricians, gynaecologists, or both, or in the sub-specialities of maternal-fetal medicine, uro-gynaecology, obstetrical and gynaecological ultrasound, gynaecological oncology and reproductive endocrinology and infertility.
Number~1400 registered specialist obstetricians and gynaecologists.20
Gender mix31% female, 69% male.

Obstetricians/Gynaecologists/Neonatologists and eHealth

Examples of relevant eHealth applications

Some example uses of eHealth that obstetricians and gynaecologists currently or could possibly benefit from include:
  • One major eHealth driver is the ability to reduce the volume of physical records in a practitioner’s office or, after retirement, home. This is particularly relevant for obstetricians because those who deliver babies need to retain medical records for up to 25 years (patients have up to seven years after the age of 18 to lodge a malpractice claim)
  • A secondary driver is the simplified collection of perinatal statistics because the current processes are typically ad hoc and differ widely between States. The uploading of data into registers also stands to be improved through use of eHealth
  • Online applications which enable patients to track progress with their pregnancy and newborn, and monitor any associated health issues also present an opportunity in this area.

Current eHealth ‘position’

  • Despite relatively low agreement that computer use is expected in their specialty, actual use of computers and eHealth technologies among obstetricians and gynaecologists is consistent with the average across all medical specialties. The segment records especially strong computer use for scheduling, billing and patient communication (outside of consultations)
  • This segment has a relatively low appetite for accessing shared patient records (due to the more insular nature of the specialty, which has more limited need for sharing patient records as their patients are often generally healthy). In particular, practitioners perceive very little benefit for enhanced continuity or quality of care from eHealth tools
  • The key barriers to greater eHealth use for obstetricians and gynaecologists are concerns about system malfunctions and risks associated with sharing and visibility of practitioner performance data (which appears consistent with practitioners’ concerns about minimising their exposure to indemnity claims). Other concerns include the process to assign identifiers to newborns which the College perceives is not being addressed, the management of ‘family files’ maintained by medical geneticists, and remote access to diagnostic images through the provider’s firewall
  • Due to the sensitive nature of reproductive health, obstetricians and gynaecologists are more concerned than most other specialist groups about privacy issues associated with shared electronic health records in the private sector.

Key insights from eHealth readiness survey

  • Computer use for obstetricians and gynaecologists is in line with the average across all specialists with the following exceptions:
    • Practice management applications are more common: 89 percent use computers for billing and patient rebates (versus 66 percent of all medical specialists) and 71 percent use computers for patient booking and scheduling (versus 60 percent of all medical specialists
    • 28 percent use computers to communicate with patients outside of consultations, versus just 17 percent of all medical specialists
    • Obstetricians and gynaecologists are less interested in interactive decision support for ordering tests (53 percent do not use or need versus 37 percent of all medical specialists)
  • 45 percent of obstetricians and gynaecologists do not use any form of computerised records. Of the obstetricians and gynaecologists who do use computers, approximately two-thirds use an electronic health record system
  • Obstetricians and gynaecologists are much more likely to use telehealth (18% currently use, versus 9% of all medical specialists). A further 33 percent stated that they definitely or probably will start using teleheath within the next three years. Of these, 64 percent are interested in consultations with other healthcare providers and 58 percent are interested in telehealth for training
  • Compared with other specialities, obstetricians and gynaecologists are less likely to agree that most practitioners in their network use computers (38 percent strongly agree versus 55 percent of all medical specialists) and are less interested in shared patient summaries (35 percent strongly agree versus 51 percent of all medical specialists). During interviews, obstetricians and gynaecologists mentioned that they generally obtain all of the information that they need through discussions with their patients and some expressed hesitance to trust records from other practitioners for this purpose
  • Obstetricians and gynaecologists are especially concerned about system malfunctions and downtime, which was the most commonly cited barrier (47 percent strongly agree). To a lesser degree, they are also concerned about technology maturity (28 percent prefer for technology to be established before using), patient privacy breaches (28 percent) and external connectivity (28 percent). Other than an above-average concern about system malfunctions, agreement levels on perceived barriers were consistent with agreement among medical specialists in general
  • Obstetricians and gynaecologists are most influenced by professional bodies (17 percent), which is consistent with medical specialists overall. They were significantly less responsive to financial incentives (just 11 percent strongly agree) as compared with other specialists.

Characteristics and practice attributes

Distribution by age and state

Although two thirds of practising specialists are male, 21 there is an increasing feminisation of the workforce and the sex ratio of specialists under 40 years old differs markedly from the segment overall. 22 Consistent with other professions, the majority (84 percent in 2003) practice in metropolitan areas. 23 The average age of specialists is 50.3 years.

General workforce trends

Solo private practice is the most common practice type although the feminisation of the workforce is causing practice structures to change as women are forming group practices where they cover each other.

Workforce pressure is common in obstetrics as this is the most demanding area, requiring almost constant on-call periods in private practice. Many obstetricians cease practice and focus on gynaecology once they have family responsibilities or get older, leading to significant shortages of obstetric specialists.

A high-level practice profile of survey respondents suggests:
  • Moderate patient volumes. Nearly half of respondents see 6-15 patients per day, and 40 percent see 16-25 patients daily
  • Few practice locations. Nearly 60 percent of respondents practice in only one or two locations
  • Strong private sector service. Nearly 80 percent of respondents earn more than half of their income from the private sector. Many people take out private health insurance for the purpose of having choice of doctor and hospital when they decide to have children. The sensitive nature of reproductive health is an additional motivating factor for women seeking care in the private sector.
EXHIBIT 34
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Education, registration and accreditation

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) trains and accredits doctors throughout Australia and New Zealand in the specialties of obstetrics and gynaecology, through initial qualification and continuing professional development. The Royal Australian College of Physicians (RACP) trains and accredits neonatologists and perinatal specialists.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
254 - 260 Albert Street, East Melbourne, VIC 3002
T: +61 3 9417 1699
F: +61 3 9419 0672
http://www.ranzcog.edu.au

The Royal Australian College of Physicians
145 Macquarie Street
Sydney
NSW 2000 Australia
T: +61 2 9256 5444
F: +61 2 9252 3310
http://www.racp.edu.au

The RANZCOG offers postgraduate training in obstetrics and gynaecology to medical graduates who have completed at least two years of general hospital training, and who are successful in gaining a training position.
  • Membership/fellowship training involves six years of postgraduate hospital-based training and assessment
  • Sub-specialty certification in one of the five sub-specialty areas offered requires a further three years training
  • Diploma training is a six-month program for general practitioners (GPs) wishing to gain additional experience and knowledge in the areas of obstetrics and basic gynaecology
  • Overseas trained doctors who have been granted partial recognition of their obstetrics and gynaecology qualifications and experience may have to complete two years of post-Membership training as an OTS trainee.

The Royal Australian College of Physicians’ Physician Readiness for Expert Practice (PREP) program provides comprehensive education and training for neonatal and perinatal medicine. Advanced Training in neonatal/perinatal medicine is for three years following satisfactory completion of three years basic paediatric training and the FRACP examination in paediatrics. RACP guidelines indicate that the Advanced Training program should be closely related to a comprehensive training program in obstetrics.

Sources of financial reimbursement/role in the healthcare ecosystem

Obstetricians and gynaecologists operate in both the public and private hospital sectors, as well as academic positions tied to public hospitals. The 2003 RANZCOG workforce survey estimated that 36 percent of its fellows practiced obstetrics in the private sector only, 34 percent in the public sector only and 30 percent in both sectors and projected the proportion practising only in the private sector to decline to 23 percent by 2009. 24 Referral from a GP is required to access Medicare benefits for obstetrics and gynaecology.

In the private sector Medicare reimburses patients for visits to a specialist 85 percent of the Medicare scheduled fee. In addition, the doctor may choose to charge a further gap above the scheduled fee. This is common practice in obstetrics due to shortages of obstetricians, particularly in regional areas. Quarterly statistics for bulk-billing rates for obstetrics in December 2010 put the rate at 37.6 percent of services.

The Extended Medicare Safety Net (EMSN) provides an additional rebate for Australian families and singles who incur out-of-pocket costs for out-of-hospital services. Out-of-hospital services include GP and specialist attendances. Once the relevant annual threshold of out-of-pocket costs has been met, Medicare will pay for 80 percent of any future out-of-pocket costs for out-of-hospital Medicare services for the remainder of the calendar year. However, as announced in the 2009-10 Budget, from 1 January 2010 there is an upper limit on the amount of benefit that can be paid under EMSN for obstetric and some associated services like assisted reproductive technology.

In 2011, the annual EMSN threshold for concession cardholders, including the Pensioner Concession Card, Health Care Card and the Seniors Health Card and people who receive Family Tax Benefits (Part A) is $578.60. For all other singles and families the annual threshold is $1,157.50. These amounts are indexed by Consumer Price Index on 1 January each year.

Where people receive their treatment in-hospital as a private patient they are eligible for a Medicare rebate equal to 75 percent of the Medicare Schedule fee. If they hold Private Health Insurance (PHI), they may also receive a rebate from their PHI fund.
Patients receiving obstetric and gynaecology services in the public hospital system are treated free of charge, however they are not eligible for choice of doctor and may be treated by trainees who are supervised by the specialist on call.

Medical indemnity claims

Typically, obstetricians face more claims than other specialties, and the settled value of these claims is higher. In 2007–08 obstetrics was the most common clinical service context for all claims (18 percent). As at June 2008, the clinicians practicing the specialty ‘obstetrics only’ accounted for 26 percent of current claims with reserve of $500,000 or more, compared with just 14 percent of total current claims and more than 3 percent of obstetrics claims closed between 2003–04 and 2007–08 settled for more than $500,000.25


20AIHW Medical Labour Force Survey 2008, published in 2010.
21Statistics from the RANZCOG 2010 practice profile, available from the RANZCOG website.
222003 RANZCOG workforce survey.
23Australian Medical Workforce Advisory Committee, ‘The specialist Obstetrics and Gynaecology workforce in Australia’, April 2004.
24 RANZCOG, ‘The 2003 RANZCOG workforce survey’, 2003.
25Australian Institute of Health and Welfare, ‘Australia’s public sector medical indemnity claims 2007–08’, 2011.