AAA<\/p>\n
On March 4 last year, I received an email that, in one sentence, explains how regional health care dies. \u201cUnfortunately, currently the [district] is not in a fiscal position to engage another gastroenterologist,\u201d a senior manager wrote. \u201cWe can revisit this on an annual basis.\u201d<\/p>\n
I am a gastroenterologist in Port Macquarie. I\u2019ve 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.<\/p>\n
I had read a similar sentence before. In December 2019, the district\u2019s then medical services director emailed us: \u201cWe are in no position to be recruiting a fourth gastroenterologist.\u201d 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\u2019s general manager conceded in writing that this was \u201ca risk to patient safety\u201d. The risk was documented. The fourth gastroenterologist was never funded.<\/p>\n
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Regional Australians are older and sicker, yet this is where specialist care is thinnest.iStock <\/p>\n
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, \u201cbarely sufficient for the supervision of a full-time trainee\u201d.<\/p>\n
The district\u2019s answer opened this article. In June 2025, the college spelled out the risk: \u201cIf one of the current supervisors leaves the public system, this position would not fulfil accreditation requirements.\u201d Its other conditions were an inventory of poverty; we could not even offer the trainee a desk.<\/p>\n
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Stuart KostalasGavin Moroney Photography<\/p>\n
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 \u201cwould no longer be required\u201d. On January 21, 2026, I was given three months\u2019 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.<\/p>\n
The poverty is real: a ministry review has the district cutting about 160 positions. But the college accredits hospitals, not spreadsheets.<\/p>\n
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.<\/p>\n
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.<\/p>\n
Related Article When I objected in writing to an executive\u2019s sneer at a recruit over vaccination paperwork \u2013 \u201cOne wonders why he\u2019s so reluctant\u201d \u2013 the acting district director of medical services replied: \u201cI want you to refrain from this kind of public feedback to your manager, please.\u201d A reply-all, apparently, is \u201cpublic feedback\u201d.<\/p>\n My emails and letters to the district\u2019s 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.<\/p>\n 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.<\/p>\n 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.<\/p>\n Related Article The fixes are unglamorous. Fund four properly appointed public gastroenterologists, one more than the college\u2019s 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.<\/p>\n \u201cWe can revisit this on an annual basis,\u201d 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: \u201cPort Macquarie Base Hospital does not currently meet the minimum requirements for accreditation \u2026 Accordingly, accreditation lapsed on 1 April 2026.\u201d<\/p>\n 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.<\/p>\n Get a weekly wrap of views that will challenge, champion and inform your own. Sign up for our Opinion newsletter<\/a>.<\/p>\n Save<\/p>\n You have reached your maximum number of saved items.<\/p>\n![\"Medicine](\"https:\/\/www.newsbeep.com\/il\/wp-content\/uploads\/2026\/08\/4d7a5ea457cf1ed7ac9dbadf732f7f9dca181c49.jpeg\")
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