Jack Anderson is about to turn four. Like his little brother Ripley, he was born prematurely.

For three years Jack was on a waiting list to be assessed for autism and ADHD, conditions for which, according to Autism Awareness Australia, early intervention and access to timely, specialised support is crucial. 

His mother, Maddison Wood, said Jack’s occupational therapist had “pushed” for the assessment, which led to his eventual diagnosis, since he was about eight months old.

Ripley, who is almost one, was born with kidney and pancreatic abnormalities, as well as a severely clubbed foot.

Ms Wood said she had spent around $50,000 in the past year mainly on Ripley’s health needs, including travel to Adelaide to visit paediatric specialists not available in her home town Mount Gambier.

While long waiting lists and limited access to paediatric specialists is not unique to rural South Australia — there’s a shortage of paediatricians nationwide — it is cold comfort for families told of the importance of early intervention only to be unable to access it. 

A shortage of paediatricians nationwide is a challenge for families.(ABC News: Jake Sturmer)

Rural Doctors Association of SA president Bill Geyer said there were “a number of things at play” when it came to better access to paediatric services in rural areas, but top of the list was the shortage of resident specialists.

“The state government had a think-tank in December 2022 looking at this issue, and obstetricians and paediatricians were the two specialists shown to be most lacking in rural areas,” he said. 

“The Rural Doctors Workforce Agency provide fly-in fly-out specialists travelling across the state, but waitlists are substantial.”

Bill Geyer says rural areas face heightened shortages of paediatricians and obstetricians.(Supplied)

Dr Geyer said the industry was improving rotations for trainee specialists to go to country areas with the hope they might get a taste for rural life and choose to stay.

“Fly-in fly-out services are better than nothing, but you can’t beat having resident specialists who provide continuity of care.” 

Shortage bites nationwide

According to the Royal Australasian College of Physicians (RACP), there is no shortage of interest in specialist paediatric positions; it says the limiting factor is available government funding to expand specialist training programs.

“Unfortunately there remains a significant shortage of non-GP specialists in many rural and regional areas,” president Jacqueline Small said.

Dr Small said the RACP administered about 380 specialist training program positions across Australia, but “this number of places is unlikely to be enough to address the under-resourcing in regional areas”.

In 2022, it was revealed in the West Australian parliament that children were waiting up to 16 months to see a paediatrician in the public health system, and 10 months for an appointment with a clinical psychologist.

Research by Perth paediatrician Lana Bell found that a third of private paediatricians and private child psychiatrists had closed their books completely, and another third had waitlists of more than six months.

The findings prompted the federal government to commit to increasing the number of GPs and allied healthcare workers in regional areas, but Ms Wood said there was a significant gap in specialist services.

“The specialists aren’t here, or if they do fly in, it’s almost impossible to get an appointment.”

She said her family travelled to Adelaide “every two or three weeks” to access specialist paediatric services for the boys.

“Being a parent, you know when something is wrong with your child but trying to get them diagnosed is a long, long road.

“We’ve encountered 12 to 24-month waitlists to get into a paediatrician.

“If you can get in to see an [occupational therapist] or a different type of specialist, sometimes they will push for you to get the appointment with a paediatrician, otherwise you’re on your own and you have to keep calling and calling.

“Waiting almost three years for an assessment is crazy.”

500-kilometre round trips

The McElroys travel every two to three weeks for medical care for their son, Chace.(Supplied)

Coonawarra mother Khloe McElroy is experiencing similar long wait times to get support for her son Chace, who was also born prematurely. 

In Mount Gambier, a city of about 28,000 people, there is just one resident paediatrician, who is supported by locums.

“Chace has ongoing health issues, recurring illnesses and is in hospital in Mount Gambier every two to three weeks,” Ms McElroy said. 

She said they had tried to find a paediatrician and started sending out referrals in February; after sending about 10 through their GP they were able to see one in April. 

Khloe McElroy is enduring long wait lists and travel to access specialist care for her son.(Supplied)

“Everyone kept declining. We even tried to go private and still couldn’t get an appointment until a paediatrician in Warrnambool [across the border in Victoria] sent a direct letter stating that it is not OK to refuse treatment for a patient who is failing to thrive.

“[They said] if the local paediatricians are doing that, then the medical board needs to be contacted.

“We finally did get to see a paediatrician in Mount Gambier but then the next available appointment was another three-month wait. It’s extremely frustrating and heartbreaking.”

She said getting an appointment seemed to be a case of being the loudest voice and continuing to call, sometimes daily, for appointments.

“But if you don’t advocate for your child, who will?”

Employers unable to attract, retain specialists

Heather Cary, who runs speech pathology clinic Communicate Better in Mount Gambier, said there was a nationwide shortage of professionals in her industry, but the situation was “far worse” in rural and regional areas.

“Unfortunately I have an extensive waitlist — children are waiting two to three years for speech pathology support,” she said.

Ms Cary has two allied health assistants in her practice and more than 30 clients ranging from babies to teenagers.

“I have tried to recruit more speech pathologists but they’re just not in the community.

“It’s very frustrating and sad because communication is a basic human right and children should not be waiting for these services.

Heather Cary says young people on lengthy waitlists can fall behind or develop behavioural issues.(ABC South East SA: Liz Rymill)

“The impacts of delayed support can cause further gaps in the child’s communication development, but it can also cause a range of behaviours as well because the child is so frustrated being unable to communicate.

“I will often tell families to get on every waitlist in town or trial telehealth services so they can get some support in place, but even that is tricky because there’s nationwide shortages of speech pathologists.”

Specialists needed as cities grow

Jessie Bilal, the practice manager at Mount Gambier’s Village Medical Centre, speaks to hundreds of families trying to access specialist medical care.

“It can be really heartbreaking when patients need to access specialist services which are not available locally.”

She said families really had only two choices:

  • to travel with minimal reimbursements from PATS (Patients Assistance Transport Scheme), placing them under financial stress and isolating them from family and support networks; or
  • to be placed on lengthy waiting lists for an appointment closer to home.

Ms Bilal said regional areas were in dire need of funding for additional services, which included enticing specialists to live or travel to regional areas.

“The city has grown so much post COVID, and our health infrastructure needs an entire overhaul to be able to sustain our community’s needs as it continues to grow,” she said.

Families choose to live apart

Mount Gambier mother of two Eva Kovacs said she and her partner made the difficult decision to separate their living arrangements to accommodate their children’s needs.

“The boys, born with the rare genetic disorder Prader-Willi syndrome, now live with their father in Geelong in Victoria so they can access specialist care,” said Ms Kovacs, who remains in Mount Gambier for work and other family commitments.

She said she saw her boys during school holidays, “which isn’t ideal”.

“They aren’t always able to travel back to Mount Gambier, and the car trip is hard on them, so I go to them or we meet half way.

“If we could access medical care and regular specialist support locally, more families could stay together.” 

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