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Dr Judith Gardiner

06 September 2020


Dr Judith Gardiner

I am an advanced RANZCOG Diplomate and the current Chair of the RANZCOG Diplomates’ Committee and Vice Chair of the Conjoint Committee for the Diploma of Obstetrics & Gynaecology. In these roles I represent Diplomates on the RANZCOG Board, Council and various committees and working groups. I am also a co-ordinator for the DRANZCOG OSCE which has proved challenging in the current pandemic. I have been a GP Obstetrician since 1980 working in regional, rural and remote locations in Victoria, Queensland and the Northern Territory and am currently semi-retired in NSW with occasional locum work predominantly in Gove where I worked full time for three years. I am a passionate advocate for GP Obstetrics and understand the difficulties of juggling an obstetric career with raising a family. 

Read below about Judith's thoughts about the training and support of Diplomates.

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As Diplomates bear the brunt of obstetric services in rural and remote areas my main focus is in the training and support of Diplomates.

1. How do we encourage Diplomates out into rural and remote locations where they are desperately needed?

Over the years Diplomates have gone from a regular presence in all hospitals (including major urban hospitals) caring mainly for uncomplicated births in association with their specialist colleagues into predominantly rural and remote locations. As the number of specialists has increased Diplomates have been eased out of urban and regional hospitals. We need our Diplomate trainees to have some links with rural practitioners and qualified Diplomates as well as some understanding of what rural obstetric practice entails. Trainees at present do not even need to have a Diplomate supervisor so could undergo their whole training in a tertiary hospital with specialists and trainee Fellows and no contact whatsoever with what we are hoping they will become. "You cannot be what you cannot see”

I recommend that we:

1. re-introduce Diplomates into regional hospitals for clinics and labour ward cover.
2. re-introduce a requirement for a Diplomate supervisor for all trainees - contact can be via zoom meetings and/or time spent during training in a rural practice

2. How do we support newly qualified Diplomates moving out to rural and remote practices?

- Traditionally this would be achieved via mentorship from more experienced GP Obstetricians and some practices can still offer this support.

- Many rural and remote practices now have only 1 or 2 GP Obstetricians and many rely on locum services entirely. This is not a well supported environment for newly qualified Diplomates to enter the workforce. They often have little support or understanding of their needs or recognition of their skills from their specialist colleagues and are often bullied by senior midwifery staff. This can be very frightening especially with today’s workforce expectations and medicolegal concerns. 

I recommend:

1. Ongoing support for Diplomates from their training hospital
2. Established mentorship by existing GP Obstetricians - preferably in a similar location/region.
3. Appropriate support by RANZCOG for Diplomates when disputes arise between Diplomates and other senior staff.

3. How do we keep Diplomates in rural and remote locations?

- Traditionally the country GP would settle at one location for his/her working lifetime and deliver several generations of babies.

- This generation of GP Obstetricians are moving rapidly to retirement

- We can no longer expect Diplomates to remain in the one location long term - predominantly due to the needs of their spouse and children. 

Country towns are a great place to raise a young family but have limitations in schooling and employment opportunities.

It is no longer common practice for a whole family to fit in with the employment needs of one parent.

- Upskilling is now an integral part of skills maintenance especially when your day to day practice does not have a high obstetric workload and your practice is relatively isolated so that there is limited in access to regular training sessions.

I recommend:

1. Consideration should be given to the future workforce in rural and remote locations in Australia. A greater number of Diplomates will be required to take over from an ageing workforce that worked extended hours and remained based at one location. 
2. Diplomates need to be incentivised to work in these locations.
3. Upskilling opportunities should be formalised, subsidised and recognised as an important component of maintaining safe obstetric practice in rural and remote communities.”



 



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