Obstetrics and Gynecology (O&G) has always been considered a challenging specialty due to the complications that can occur unexpectedly while a baby is being born.

Recently, a male O&G physician in his mid-30s committed suicide as a result of tedious working hours which resulted in a psychological condition. The physician had clocked up to “208 hours of overtime in a month” and upon investigation, the death was classified as “work-related”.

Lack of O&G specialists poses a global mortality threat

In Singapore, the number of births in 2014 was 2000 more than the year before. However, in the past five years, there is a decrease in the number of doctors aspiring to specialize in O&G. This is in direct conflict with the steady increase in the number of births, as a proportionate number of adequately qualified professionals is needed to ensure that the births occur smoothly.

Datuk Dr. Noor Hisham Abdullah, the director-general of Malaysia’s Ministry of Health (MOH), commented on this inequality in both private and public sectors two years ago: “With the obstetrics and gynaecology specialists almost equal in numbers in both sectors, there is definitely going to be increased demand. We will not face a shortage of O&G specialists but rather a mismatch in the distribution and the corresponding workload.”

More recently, the NHS reported a dire shortage of qualified doctors and midwives in the maternity wards. The lack of specialist staff was reported to be so severe that many women are denied one-to-one care during labour, according to the first national maternity and perinatal audit (NMPA).

Elizabeth Duff, senior policy advisor at the National Childbirth Trust (NCT), “Inadequate staffing levels cause ‘red flag’ events when women don’t receive essential care in a timely fashion. This may include delayed provision of prescribed medication such as painkillers or antibiotics, risking exacerbation of a dangerous infection.”

High risks of running in with the law

Many obstetricians in private practice leave their jobs due to the many lawsuits and increasing legal action they face. This is a consequence of the changing demographic of patients’ families, who harbour greater expectations from doctors. In 2014, the number of lawsuits for O&G under the Malaysia’s MOH was estimated to be 18; 10 more, compared to 2013.

Just last month, Dr Thaneemalai Jeganathan, the President of the Obstetrics and Gynaecology Society of Malaysia said that one of the obstacles that the O&G community is the decreasing number of trainees or medical students choosing to specialize in O&G despite the rising numbers of physicians.

He further remarked that this could be due to the risk of being involved in litigations. Coupled with the rise in litigations, a substantial number of obstetricians quitting the field, presenting the O&G community with a dire problem that needs to be addressed as soon as possible.

This may also negatively impact the doctor-patient relationship. Changes in indemnity insurance have also resulted in senior private physicians reconsidering participating in childbirth operations.

High indemnity costs reduce numbers of O&G doctors

For private O&G specialists, the Medical Protection Society (MPS) amended its policy for O&G specialists in 2015, from occurrence-based protection to claims-based coverage. This meant doctors must pay annual premiums for 25 years as an individual is entitled to pursue legal action against a physician up to 24 years after his or her birth.

This applies to doctors who retire as well. According to the MPS, the changes were made due to global challenges and risks associated with obstetric claims and litigations. As compensation, can amount to millions, O&G specialists are demotivated to continue working due to the fear of committing mistakes. Defensive medicine may be practiced, which would also affect the quality of care.

O&G specialists in public hospitals are indemnified by most governments. However, with the increased workload and stress in many government sectors, experts doubt indemnification will last.

This translates into a greater burden on public O&G healthcare, which may cause poorer health outcomes, due to overstretched working hours, longer waiting times and sub-optimal care.

If births continue to rise in the future and increasing number of physicians choose to leave O&G services, this may create a serious mismatch of demand and supply in the future. What can be hoped for is that national organizations step in and help doctors pay their coverage even after post-retirement by charging all doctors a small fee annually. MIMS

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