Source : the age
On March 4 last year, I received an email that, in one sentence, explains how regional health care dies. “Unfortunately, currently the [district] is not in a fiscal position to engage another gastroenterologist,” a senior manager wrote. “We can revisit this on an annual basis.”
I am a gastroenterologist in Port Macquarie. I’ve spent nearly 15 years caring for a catchment of a quarter of a million people, and until this year I was head of gastroenterology at Port Macquarie Base Hospital.
I had read a similar sentence before. In December 2019, the district’s then medical services director emailed us: “We are in no position to be recruiting a fourth gastroenterologist.” We had asked because three of us could not cover every week without burning out. One week in four each was sustainable; the fourth week had no cover. In April 2020, the hospital’s general manager conceded in writing that this was “a risk to patient safety”. The risk was documented. The fourth gastroenterologist was never funded.
In November 2024, the Royal Australasian College of Physicians, which accredits hospitals to train specialists, surveyed our department. The public gastroenterology service relied on three visiting specialists whose sessions totalled 0.6 of one full-time position, “barely sufficient for the supervision of a full-time trainee”.
The district’s answer opened this article. In June 2025, the college spelled out the risk: “If one of the current supervisors leaves the public system, this position would not fulfil accreditation requirements.” Its other conditions were an inventory of poverty; we could not even offer the trainee a desk.
Then the district did the one thing the college had warned against. In December 2025, it wrote that under a new staffing model my contract “would no longer be required”. On January 21, 2026, I was given three months’ notice of termination. On April 1, 2026, accreditation lapsed; my termination took effect three weeks later. A public service that cannot survive the loss of one part-time specialist is not a service. It is a coincidence with a roster.
The poverty is real: a ministry review has the district cutting about 160 positions. But the college accredits hospitals, not spreadsheets.
We are told the regions cannot attract specialists. This is not true. In 2017, I recruited an outstanding hepatobiliary interventional endoscopist, trained in Australia and at a Canadian liver transplant centre, the specialist you want when a scan shows a pancreatic mass or you turn yellow. He moved to town and worked eight years without a public hospital contract.
His endoscopic ultrasound service, the test that confirms pancreatic cancer and shows whether it can still be cured, was available here only to the privately insured, while public patients with suspected cancer travelled nearly three hours down the highway. In mid-2025, he stopped waiting and moved back to a major city. The endoscopic ultrasound service left with him.
When I objected in writing to an executive’s sneer at a recruit over vaccination paperwork – “One wonders why he’s so reluctant” – the acting district director of medical services replied: “I want you to refrain from this kind of public feedback to your manager, please.” A reply-all, apparently, is “public feedback”.
My emails and letters to the district’s chief executive have gone unanswered since early 2025. Even my termination letter instructs me not to discuss this matter with anyone. Consider this article the exit interview nobody scheduled.
And count what this town has lost. The training post that produced its next generation of specialists. The ultrasound service that detected pancreatic cancer early, when intervention can still cure it or buy years. The early cancer resections performed by its terminated head of department. What remains is a waiting list and a highway.
And need runs opposite to access: regional Australians are older and sicker than their city counterparts, more likely to have bowel cancer found late and less likely to survive it, yet this is where specialist care is thinnest.
The fixes are unglamorous. Fund four properly appointed public gastroenterologists, one more than the college’s bare floor. The next time a specialist moves to town and offers, employ them. Set rosters with the specialists who fill them. And when a head of department writes to the chief executive about a collapsing service, answer.
“We can revisit this on an annual basis,” the district wrote in March 2025. The year passed. The district has repeated the same sentence since 2019. The college finally replied regarding the gastroenterology training: “Port Macquarie Base Hospital does not currently meet the minimum requirements for accreditation … Accordingly, accreditation lapsed on 1 April 2026.”
Professor Stuart Kostalas is a gastroenterologist, director of endoscopy and chair of the medical advisory committee at Port Macquarie Private Hospital, a former head of the department of gastroenterology at Port Macquarie Base Hospital, and a conjoint professor of medicine at UNSW.
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