The Obstetrics and Gynaecology Workforce in Australia

Australian Medical Workforce Advisory Committee
THE OBSTETRICS AND GYNAECOLOGY

WORKFORCE IN AUSTRALIA
SUPPLY AND REQUIREMENTS
1997 - 2008
AMWAC Report 1998.6

August 1998
AMWAC 1998.6
Australian Medical Workforce Advisory Committee 1998

ISBN 0 7313 4096 5
This work is copyright. It may be reproduced in whole or part for study or training
purposes subject to the inclusion of an acknowledgement of the source. Reproduction
for purposes other than those indicated above requires the written permission of the
Australian Medical Workforce Advisory Committee.
Enquiries concerning this report and its reproduction should be directed to:
Executive Officer
c/- New South Wales Department of Health
Locked Mail Bag 961
NORTH SYDNEY NSW 2059
Telephone: (02) 9391 9933
E-mail:
amwac@doh.health.nsw.gov.au
Internet:
http://amwac.health.nsw.gov.au
Suggested citation:
Australian Medical Workforce Advisory Committee (1998), The Obstetrics and
Gynaecology Workforce In Australia, AMWAC Report 1998.6, Sydney
Publication and design by Australian Medical Workforce Advisory Committee.

Printing by Copybook, Sydney.
ii
AMWAC 1998.6
CONTENTS
Abbreviations
vi
List of Tables and List of Figures
viii
Terms of Reference of AMWAC and the AMWAC Obstetrics and

Gynaecology Workforce Working Party
xi
Membership of AMWAC
xii
Membership of the AMWAC Obstetrics and Gynaecology Workforce

Working Party
xiii
Introduction, Guiding Principles and Methodology
Part A:
The Specialist Obstetrics and Gynaecology Workforce
Summary of Findings and Recommendations
Description of the Current Obstetrics and Gynaecology Workforce

The Number of Practising Obstetrics and Gynaecology Specialists
Distribution of the Obstetrics and Gynaecology Workforce
Age Profile
Gender Profile
Hours Worked
Practice Profiles
Services Provided
Training Arrangements
Summary of Main Characteristics of the Specialist Obstetrics and
Gynaecology Workforce
19
19
20
22
26
27
31
32
34
Adequacy of the Current Obstetrics and Gynaecology Workforce

Obstetrics and Gynaecology Specialist:Population Ratio
Public Hospital Vacancies
Provider Shortages
Consultation Waiting Times
Survey of Divisions of General Practice
Professional Satisfaction
Conclusions on Adequacy of the Current Obstetrics and
Gynaecology Workforce
41
41
45
45
45
46
47
Projections of Requirements
48
iii
39
47
AMWAC 1998.6
Female Population
Fertility Rate
Birth Rate
Cancer of the Cervix, Ovary and Uterus
Trends In Utilisation
The Impact of Changes in Technology
Specialists Perceptions of Factors Affecting Workforce Requirements
48
49
50
52
53
55
55
Projections of Supply
Additions and Losses to the Obstetrics and Gynaecology Workforce 56
Female Participation in the Workforce
Provision of Services in Rural and Remote Areas
Substitution of Services
56
57
57
Balancing Supply Against Requirements

Requirement Trends
Supply Trends
Projected Balance
62
62
64
65
Recommendations
71
Part B:
73
The Sub-Specialist Obstetrics and Gynaecology Workforces
56
Introduction
74
Characteristics of the Obstetrics and Gynaecology Sub-specialist

Workforce
Number of Practising Sub-specialists in Obstetrics and Gynaecology
Distribution of the Sub-specialist Workforce
Age Profile
Gender Profile
Hours Worked
Practice Profiles
Obstetrics and Gynaecology Sub-specialist:Population Ratios
77
77
77
79
81
82
84
84
87
iv
AMWAC 1998.6
Appendices
Appendix A: Rural, Remote and Metropolitan Areas Classification
Appendix B: RACOG/AMWAC Survey of Fellows of the Royal Australian
College of Obstetricians and Gynaecologists
Appendix C: AIHW National Medical Labour Force Survey 1995
Appendix D: Service Provision and Requirements of Obstetrics and
Gynaecology
Appendix E: RACOG Obstetrics and Gynaecology Training Program
Appendix F: General Practitioners Providing Obstetrics and Gynaecology
Services
Appendix G: AMWAC Survey of Divisions of General Practice
Appendix H: Data on Midwives
Appendix I: AIHW National Hospital Morbidity Data for Obstetrics and
Gynaecology
References
90
92
111
116
119
123
131
137
145
161
iv
AMWAC 1998.6
ABBREVIATIONS
ABS
Australian Bureau of Statistics
ACT
Australian Capital Territory
AHMAC
Australian Health Ministers' Advisory Council
AIHW
Australian Institute of Health and Welfare
AMWAC
AN-DRGs
Australian National Diagnostic Related Groups
Aust
Australia
CREI
Certificate of Reproductive Endocrinology and Infertility
CSCT
Certificate of Satisfactory Completion of Training in Womens

Reproductive Health
DHFS
Commonwealth Department of Health and Family Services
DRACOG
Diploma of the Royal Australian College of Obstetricians and

Gynaecologists
FRACOG
Fellow of the
Gynaecologists
FRACP
Fellow of the Royal Australian College of Physicians
FTE
Full time equivalent
GONC
Gynaecological Oncology
GP
General Practitioner
HIC
Health Insurance Commission
HMO
Hospital Medical Officer

(also known as Career Medical Officer or CMO)
ICD-9
International Classification of Diseases, Ninth Revision
ITP
Integrated Training Program
MBS
Medicare Benefits Schedule
MDC
Medical Diagnostic Category
MDS
Minimum Data Set
MFM
Maternal Fetal Medicine
Australian
College
of
Obstetricians
and
AMWAC 1998.6
MRACOG
Member of the Royal Australian College of Obstetricians and

Gynaecologists
NASOG
National Association of Specialist Obstetricians and Gynaecologists
NSW
New South Wales
NT
Northern Territory
O&G
Obstetrics and Gynaecology
O&GULT
Obstetrical and Gynaecological Ultrasound
OS
Overseas
Pop
Population
Qld
Queensland
RACGP
Royal Australian College of General Practitioners
RACOG
Royal Australian College of Obstetricians and Gynaecologists
RRMA
Rural, Remote Metropolitan Areas classification
SA
South Australia
Spec
Specialist
SPR
Specialist:Population ratio
SRAC
Specialist Recognition Advisory Committee
SSPR
Sub-specialist:Population ratio
Tas
Tasmania
Terr
Territory
TRD
Temporary Resident Doctor
UK
United Kingdom
UROG
Uro-gynaecology
Vic
Victoria
VMO
Visiting Medical Officer
WA
Western Australia
vi
AMWAC 1998.6
LIST OF TABLES
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Obstetrics and gynaecology specialists to population, by State/Territory

Distribution of obstetrics and gynaecology specialists, by State/Territory and
geographic location (RACOG data), 1998
Age profile of the total obstetrics and gynaecology specialist workforce, by
State/Territory and gender (RACOG data), 1998
Age profile of the total obstetrics and gynaecology specialist workforce, by
State/Territory, gender and major age group (RACOG data), 1998
Age profile of obstetrics and gynaecology specialists, by State/Territory and
gender (RACOG data), 1998
Age profile of obstetrics and gynaecology specialists, by State/Territory and
major age group, 1998
Specialists and sub-specialists in obstetrics and gynaecology average hours
provided per week, annual labour supply hours by State/Territory, 1998
Specialists and sub-specialists in obstetrics and gynaecology average hours and
annual hours worked, by gender and age group, 1998
Hours worked by specialists in obstetrics and gynaecology, by geographic
location, 1997
Obstetrics and gynaecology services attracting Medicare benefits provided by
specialists, 1986-87 to 1996-97
Accredited obstetrics and gynaecology training positions, by hospital and
State/Territory, 1998
RACOG trainees, by year of training, age group and gender, 1998
RACOG trainees, by full time and part time status, age group and gender, 1998
Obstetrics and gynaecology trainees, by State/Territory and gender, 1998
Obstetrics and gynaecology specialists in training average hours worked, by
gender and age, 1995
Obstetrics and gynaecology specialists in training average hours worked, by
Obstetrics and gynaecology trainees, by gender, 1992 to 1998
Specialists in obstetrics and gynaecology to female population ratio, by
State/Territory 1998 (number per 100,000 population)
Specialists in obstetrics and gynaecology to female population ratio, by
State/Territory and geographic location, 1998
Obstetrics and gynaecology average waiting time (days) for a standard first
consultation and an urgent procedure, by private rooms/public outpatients
department and State/Territory, 1997
Australian female population estimates and projections, 1997 to 2006
Total fertility rate, by State/Territory, 1976, 1986 and 1996
Total births, by State/Territory, 1996
Total births, by State/Territory, 1996
Incidence of cancer of the cervix among women aged 20 to 74 years, by
State/Territory
vii
AMWAC 1998.6
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
Age standardised rates for incidence of cancer of the cervix, ovary and uterus,
selected years 1983 to 1994, with projections to 1999
Projected increases in utilisation for obstetrical and gynaecological procedures,
1998 to 2018
Summary of obstetrics and gynaecology services attracting Medicare benefits; by
provider, selected years 1986-87 to 1996-97
Obstetrics and gynaecology Medicare services, by provider and State/Territory,
1995-96
Distribution of obstetrics and gynaecology Medicare service providers, by
geographic location, 1995-96
Projected requirements for obstetrics and gynaecology services (in full time
equivalent hours per week) for selected indicators, 1995 to 2009
Projected supply of obstetrics and gynaecology services, high, low and average
retirement rates, by FTE hours worked per week, 1999, 2004 and 2009
Projected obstetrics and gynaecology supply and requirements (FTE hours),
0.4% growth per year, 1998 to 2004
Obstetrics and gynaecology graduate output needed to move projected supply
into balance with projected requirements, 0.4% growth per year, (in FTE hours),
1998 to 2009
Estimated obstetrics and gynaecology graduate output required to move
projected supply into balance with projected requirements, 0.4% growth per year,
(in FTE hours), by selected graduate outputs, 1998 to 2009
Distribution of obstetrics and gynaecology first year advanced trainee positions,
by State/Territory, 1999 to 2002
Number of obstetrics and gynaecology sub-specialists, by sub-specialty,
State/Territory and gender, 1998
Distribution of obstetrics and gynaecology sub-specialists; by geographic
location, 1998
Age profile of obstetrics and gynaecology sub-specialists, by State/Territory and
gender, 1998
Age profile of obstetrics and gynaecology sub-specialists, by State/Territory,
gender and major age group, 1998
Sub-specialists in obstetrics and gynaecology average hours worked per week
and annual labour supply hours, by State/Territory, 1998
Sub-specialists in obstetrics and gynaecology average hours and annual hours
worked, by gender and age group, 1998
Sub-specialists in obstetrics and gynaecology average hours worked per week,
by geographic location of main job, 1997
Obstetrics and gynaecology sub-specialty trainees, by year of training, gender
and major age group, February 1998
Obstetrics and gynaecology sub-specialty trainees, by State/Territory and
gender, February 1998
Sub-specialists in obstetrics and gynaecology female population: population
ratio, by State/Territory, 1997
viii
AMWAC 1998.6
LIST OF FIGURES
1.
2.
Obstetrics and Gynaecology Specialists supply (Average Attrition Rates) vs

Demand Projections working a 60 hour week, incorporating the current intake of
58 trainees per year.
Obstetrics and Gynaecology Specialists supply (Average Attrition Rates) vs
Demand Projections - Birth Rates and Fertility Rates - working a 60 hour week,
incorporating the current intake of 58 trainees per year.
ix
AMWAC 1998.6
TERMS OF REFERENCE OF AMWAC AND THE AMWAC OBSTETRICS AND

GYNAECOLOGY WORKFORCE WORKING PARTY
The Australian Health Ministers' Advisory Council (AHMAC) established the Australian
Medical Workforce Advisory Committee (AMWAC) to advise on national medical
workforce matters, including workforce supply, distribution and future requirements.
AMWAC held its first meeting in April 1995.
AMWAC Terms of Reference
1.
To provide advice to AHMAC on a range of medical workforce matters, including:

-
the structure, balance and geographic distribution of the medical

workforce in Australia;
the present and required education and training needs as suggested by
population health status and practice developments;
medical workforce supply and demand;
medical workforce financing; and
models for describing and predicting future medical workforce
requirements.
2.
To develop tools for describing and managing medical workforce supply and
demand which can be used by employing and workforce controlling bodies
including Governments, Learned Colleges and Tertiary Institutions.
3.
To oversee the establishment and development of data collections concerned

with the medical workforce and analyse and report on those data to assist
workforce planning.
Obstetrics and Gynaecology Workforce Working Party Terms of Reference

The AMWAC Obstetrics and Gynaecology Workforce Working Party was established as
a sub-committee of AMWAC and was asked to provide a report to AMWAC on the
optimal supply and appropriate distribution of obstetrics and gynaecology specialists
and sub-specialists across Australia, including projections for future requirements.
The Working Party held its first meeting on 5 August 1997 and presented its report to
the AMWAC meeting of August 1998. The report was accepted at the October 1998
AHMAC meeting.
AMWAC 1998.6
MEMBERSHIP OF AMWAC
Independent Chairman
Professor John Horvath
Physician, Sydney
Members
Mr Eric Brookbanks
Assistant Secretary, Business and Temporary Entry

Branch, Commonwealth Department of Immigration and
Multicultural Affairs
Ms Meredith Carter
Director, Health Issues Centre
Dr William Coote
Secretary General, Australian Medical Association
Mr Michael Gallagher
First Assistant Secretary, Higher Education Division,

Commonwealth Department of Employment, Education,
Training and Youth Affairs
Dr Susan Griffiths
General Practitioner, Minlaton, South Australia
Assoc. Prof. Jane Hall
Director, Centre for Health, Economics, Research and

Evaluation, University of Sydney
Dr Richard Madden
Director, Australian Institute of Health and Welfare
Mr Ronald Parker
Secretary, Tasmanian Department of Community and

Health Services
Professor Nick Saunders Dean, Faculty of Medicine, Monash University, Melbourne

Dr Robert Stable
Director General, Queensland Department of Health
Dr David Theile
Surgeon, Brisbane (former President, Royal Australasian

College of Surgeons)
Dr Lloyd Toft
Chairman, Medical Board of Queensland
Mr Robert Wells
First Assistant Secretary, Office of the National Health and

Medical Research Council, Commonwealth Department of
Health and Family Services
xi
AMWAC 1998.6
MEMBERSHIP OF THE AMWAC

WORKFORCE WORKING PARTY
OBSTETRICS
AND
GYNAECOLOGY
Chairman
Professor Ross Kalucy
President, Medical Board of South Australia
Members
Dr John Bates
Gynaecologist, Perth
Mr Maurie Breust
Executive Director, Strategic Planning and

Development, North West Adelaide Health Service
Dr Lawrence Brunello
President, Royal Australian College of Obstetricians

and Gynaecologists
Ms Dell Horey
Consumer representative, Maternity Alliance, New

South Wales
Dr Alan Sandford
Senior Medical Adviser, Manager Health Workforce

Section, Public Health and Development Division,
Department of Human Services Victoria
Dr Geoff Westwood
Director of Medical Services, Alice Springs Hospital
Ms Anastasia Ioannou
Senior Policy Officer, AMWAC
This report was written by Ms Anastasia Ioannou, Senior Policy Officer, AMWAC.
The Working Party would also like to acknowledge the assistance of the following
people in preparation of the report:
Professor John Horvath and Mr Paul Gavel (AMWAC) for helpful editorial
comments;
Mr John Harding and Mr Warwick Conn (AIHW) and Ms Angela Tirrizzi and Ms
Emma Gilbert (RACOG) for assistance with data collection;
Chairs of the RACOG sub-specialty committees and Professors of Obstetrics
and Gynaecology for helpful comments on particular aspects of the specialty;
Dr David Molloy, National Association of Specialist Obstetricians and
Gynaecologists (NASOG) for providing comments on the draft report;
- Dr Kathy Innes and Dr Mark Henschke for providing data on general practitioner
(GP) provision of obstetrics and gynaecology services;
xiii
AMWAC 1998.6
Mr Dean Carson (Centre For Rural Health) for data collection through the
National Rural General Practitioner Survey;
Ms Patricia Brodie (New South Wales Health Department) for editorial comment
on the summary of trends in midwife numbers; and,
Dr Derrick Bui, Medical Management Trainee, Victorian Department of Human
Services for assisting with RACOG data collection.
xiv
AMWAC 1998.6
INTRODUCTION, GUIDING PRINCIPLES AND METHODOLOGY

Introduction
In preparing this report, the Working Partys aim has been to promote appropriate
obstetric and gynaecology services throughout Australia.
The main objective of the Working Party has been to promote an optimal supply and
distribution of specialist obstetricians and gynaecologists, including projections for future
supply and requirements to the year 2008.
Obstetrics and gynaecology is a fused profession in the sense that specialists are
licensed to undertake specialist treatments in both obstetrics and gynaecology. In
addition, there are five associated sub-specialties, namely maternal fetal medicine, urogynaecology, obstetrical and gynaecological ultrasound, gynaecological oncology and
reproductive endocrinology and infertility. This report attempts to accommodate the
subdivisions within the obstetrics and gynaecology workforce by presenting information
on the total workforce and the sub-specialist workforce. To this end the report is
provided in two parts:
Part A: The Specialist Obstetrics and Gynaecology Workforce
Part B: The Sub-Specialist Obstetrics and Gynaecology Workforce
Part A includes a description of the total workforce, an assessment of the adequacy of
the total workforce and projections of total workforce supply and requirements to 2008.
Part B provides a summary of the main characteristics of each of the five sub-specialist
workforces. The report also examines obstetric services provided by general
practitioners (GPs) and midwives and most of this examination is detailed in appendices
H and J respectively.
Guiding Principles
In compiling this report, the Working Party adopted the following guiding principles:
the Australian community should have available an adequate number of trained
obstetric and gynaecology specialists, appropriately distributed to provide the
obstetric and gynaecology services it requires;
there should be high standards of training leading to qualification which ensures high
quality of practice;
the working life of specialists should be embedded within a process of continuing
education and quality assurance;
challenges to the provision of a good standard of care in obstetrics and gynaecology
need to be identified and addressed;
Australians should have access to a good standard of obstetric and gynaecology
services including related sub-specialty services, irrespective of geography and
economic status. In achieving this, convenience to the patient must be balanced
against the quality of services that can be distributed to meet that convenience;
the guiding principles should apply equally to private and public sectors.
1
AMWAC 1998.6
The Working Party defined an obstetric and/or gynaecology specialist as:

A qualified specialist who is conducting obstetric and gynaecological
consultations, obstetrics and gynaecology assessments/procedures and medico
legal consultations in obstetrics and gynaecology medicine, including being in a
full time or part time academic position relating to obstetrics and gynaecology.
The definition includes specialists in salaried positions and private practice.
An obstetrician provides medical care before, during and after childbirth.
Gynaecologists diagnose, treat and aid in the prevention of disorders of the
female reproductive system.
This definition does not include registrars in training or registrars who have completed
their training but have not successfully passed their final examination for specialty
recognition.
Methodology
The approach of the Working Party has been to analyse existing data sources and to
undertake consultation with relevant persons and organisations in order to make
informed comments on the factors affecting the current and future requirements for
obstetric and gynaecology services.
In estimating workforce numbers, establishing a profile of the workforce and assessing
its adequacy, the main sources of data were:
1.
Royal Australian College of Obstetricians and Gynaecologists (RACOG)
RACOG keeps a variety of data, principally on the number of Fellows and training posts
and age and gender information of Fellows and trainees. A survey of the 954 members
was conducted in 1997 with a response rate of 53%. A summary of the findings of the
survey is provided in Appendix B. The profile and projections of the workforce has been
based on the March 1998 RACOG figures of Australian active Fellows/Members, both
specialist and sub-specialist.
2.
Australian Institute of Health and Welfare (AIHW)
The principle AIHW data source is the annual Medical Labour Force Survey. The
Medical Labour Force Survey presents national labour force statistics for registered
medical practitioners, principally through a survey collected as part of the annual
renewal of registration. The survey data used in this report is for 1995. A summary of
the key findings for the obstetrics and gynaecology workforce are included in Appendix
C.
3.
Commonwealth Department of Health and Family Services (DHFS) Medicare

2
AMWAC 1998.6
provider database
Medicare provider statistics define medical practitioners according to the predominant
services billed to Medicare. The Medicare statistics include all practitioners who have
billed Medicare for at least one service during a financial year.
The major deficiency with the use of Medicare data for workforce planning purposes is
that it does not provide data on practitioners who are salaried obstetricians and
gynaecology specialists/sub-specialists in the public hospital system and who do not
render services on a fee for service basis. Medicare data thus excludes services
rendered free of charge to public hospital patients, to Veterans' Affairs patients and to
compensation cases.
4
Casemix data on hospital activity
The AIHW National Hospital Morbidity database (ICD-9-CM groupings) has been used
as a key source of data on service trends. The data is sourced from the AIHW
Australian hospital morbidity database for all patients in public and private hospitals in
Australia from 1993-94 to 1996-97.
5.
AMWAC Survey of Divisions of General Practice
To assist the Working Party in its assessment of the adequacy of the workforce
AMWAC administered a mailed survey of each Division of General Practice. Of a
possible 122 Divisions, 77 responded (63.1%). The results of the survey are
summarised in Appendix I.
6.
Sources of data on the non specialist workforce.
Obstetrics and gynaecology services can also be provided by non-specialists, mainly

GPs, principally in rural and remote areas, and midwives. In order to gain an insight into
the use of non-specialists and the types of services provided by non specialists the
Working Party also examined the following data sources:
AIHW, Nursing Labour Force Survey 1995
This survey presents national labour force statistics for registered nurses, principally
through a nurse labour force survey conducted by each State/Territory nurses board on
behalf of the Institute. The survey data used in this report is for 1995.
The National Rural General Practitioner Survey conducted by the Centre for Rural
Health at Moe
The survey was conducted in 1996 and collected information in regards to rural GPs
working in obstetrics and gynaecology. The majority of respondents were qualified in
either the Diploma of the RACOG (DRACOG) or the Certificate of Satisfactory
3
AMWAC 1998.6
Completion of Training in Womens Reproductive Health (CSCT). The response rate of

the survey was approximately 70% (2,100).
7.
Australian Bureau of Statistics
The Australian Bureau of Statistics (ABS) population data and projections are used as
the sole source on population data. In making its population projections ABS uses four
different series. The population projections in this report are based on Series A/B, where
constant fertility and low overseas migration are assumed (ABS 1994 and ABS 1997).
It should also be noted that where population data is provided in this report it relates to
female population only.
8.
Rural, Remote Metropolitan Areas classification
Wherever possible, distributional data has been interpreted using the rural, remote and
metropolitan areas classification (RRMA) developed by the Commonwealth
Departments of Health and Family Services and Primary Industries and Energy (DPIE
& DHSH 1994). A summary of the RRMA classification is provided in Appendix A: Rural,
Remote and Metropolitan Areas Classification.
Key Assumption
The Working Party would like to emphasise that the projections on supply and
requirements are based on the existing national health structure. If there is a change to
the national health structure the Working Party recommends the supply requirements
and projections be reviewed.
The Working Party also assumed that the current length of the RACOG training program
would remain unchanged and that the majority of candidates would complete the
program within this time frame. In addition, the Working Party has assumed that the
pattern of workforce participation of the current workforce provides a suitable basis on
which to project future workforce requirements.
AMWAC 1998.6
PART A:
THE SPECIALIST OBSTETRICS AND
GYNAECOLOGY WORKFORCE IN AUSTRALIA
AMWAC 1998.6
SUMMARY OF FINDINGS AND RECOMMENDATIONS

This report describes the current specialist obstetrics and gynaecology workforce,
assesses the adequacy of that workforce, and projects workforce supply and
requirements to the year 2008.
Obstetrics and gynaecology, with an estimated 1,049 specialists, is one of the largest
single specialties in Australia (only the psychiatry and anaesthesia workforces are
noticeably larger). However, the specialty is one of the more difficult to examine and
assess and there are several reasons for this:
1.
Obstetrics and gynaecology is a complex profession to analyse in that specialists

can practice obstetrics, gynaecology or a mixture of both, and even some of the
obstetrics and gynaecology sub-specialists continue to practice general
obstetrics and gynaecology. There also appears to be a tendency for older
specialists to do less obstetrics work. All this makes it difficult to assess who is
doing what and the level of service that is being provided.
2.
The above issue is further complicated by the variable contribution of some

service provision through the provision of obstetrics services by GPs and
midwives. Assessment of services trends is further compounded by the general
absence of national data collections that allow the separation of data by service
provider. Reliable data on the trends in GP and midwife numbers has also been
difficult to obtain.
Nevertheless the Working Party has attempted to provide information and estimates to
overcome these data shortcomings.
The report concludes that there is a slight shortage in the current workforce, perhaps
due more to maldistribution than any widespread general shortages. The Working Party
also concluded that the current level of trainee intake will need to be maintained for
projected supply to be adequate to meet estimated future requirements.
Obstetrics and gynaecology trainee intake was dramatically boosted in 1995 (from 208
trainees in 1994 to 282 trainees in 1995) and has been maintained at this level in 1996,
1997 and 1998. As a result, no short term measures have been recommended by the
Working Party to temporarily boost specialist supply because it is recognised that
shortages should begin to improve once the higher number of trainees commence
making a contribution to the workforce from 2001 onwards.
In projecting workforce supply, there were two key factors identified that would influence
the future level of trainee intake. The first is the significant number of specialists aged
55 years and over, 32.0% (336) of the workforce; and therefore likely to proceed
through to retirement in the next five to ten years. Average retirement age for this
6
AMWAC 1998.6
workforce is estimated at 63 years and only 7.0% (74) of the current workforce are aged
65 years and over.
The other key supply factor is that 55.3% of current trainees are female. This is one of
the highest levels of female trainee participation in any specialty and has potentially
significant implications for lifetime workforce contribution, given that estimates based on
current participation patterns suggests that female lifetime participation in obstetrics and
gynaecology is 74% of that of male lifetime participation. This trend is projected to
continue and has been factored into the supply projections.
Notwithstanding the future uncertainties considered above, the Working Party anticipate
that actual requirements are not expected to grow by much, only an estimated 0.4% per
annum. This estimation was arrived at following examination of eight requirement trend
indicators, including fertility rate, birth rate and service growth trends.
As indicated above, the results of the projection analysis indicate that first year trainee
intake should be maintained at the current level. Future workforce requirements have
indicated that first year trainee intake be 58 so that no significant shortfall emerges in
the workforce. However, the Working Party was advised by RACOG that a more
practical intake is around 55 trainees. Accordingly, a training program intake of 55 first
year trainees has been recommended for the next four years. It should be noted
however, that on present indications it is unlikely that this level of intake will need to be
sustained indefinitely and as such the Working Party has recommended that before the
level of trainee intake for 2003 is determined the workforce should again be reviewed,
that is by the end of 2000 to allow sufficient time to recruit the 2003 intakes.
In particular, the Working Party acknowledged that the higher level of trainee intake of
58 may cause some difficulties for RACOG in terms of available trainers and the
accumulation by trainees of necessary clinical experience. Hence, the recommended
first year trainee intake of 55 per year for the next four years, which is in fact similar to
the intake over the period 1995 to 1997.
Description of the Current Obstetrics and Gynaecology Workforce
There were various data sources used to identify the current obstetrics and gynaecology
workforce. The total workforce numbers were derived from 1998 RACOG and were
supplemented by data from the 1997 RACOG/AMWAC survey of College Fellows. The
1995 AIHW Medical Labour Force Survey was used for comparison.
Number of Practising Consultants in Obstetrics and Gynaecology
The current size of the practising obstetrics and gynaecology workforce is estimated
to be 1,049 and was based on RACOG figures, as of March 1998.
The workforce consists of 951 obstetrics and gynaecology specialists. In addition,
there are an estimated 98 sub-specialists, some of whom also provided obstetrics
7
AMWAC 1998.6
and gynaecology services.

RACOG records further show that 502 specialists consider their predominant clinical
practice to be in obstetrics (although time was also spent in gynaecology) and 79
Fellows consider their predominant area of clinical practice to be in gynaecology.
370 Fellows have indicated to the College that they spend roughly the same amount
of time in obstetrics and gynaecology.
There are five sub-specialties within obstetrics and gynaecology. The Working Party
identified 10 maternal fetal medicine specialists, 13 uro-gynaecologists, 23
obstetrical and gynaecological ultrasound specialists, 24 gynaecological oncology
specialists and 28 reproductive endocrinology and infertility specialists, as of
February 1998. Specialists can also contribute to these sub-specialty areas.
The number of sub-specialists is relatively small, making up approximately 9.3% per
cent of the profession. The main characteristics of the sub-specialists workforce are
outlined in part B of this report.
Geographic Distribution
Using three data sources (RACOG, AIHW and Medicare) the total specialist
obstetrics and gynaecology to population ratio (SPR) is estimated to range from
1:6,954 to 1:7,547 or (13.3 to 14.4 specialists per 100,000 female population 15
years and over).
RACOG data estimates the national SPR to be 1:6,954 female population. The
RACOG data shows Victoria and South Australia have the highest SPR and
Tasmania and the Northern Territory the lowest SPRs. Other States/Territories, with
a SPR better than the national average are New South Wales and the Australian
Capital Territory. The SPRs in Queensland and Western Australia are noticeably
lower than the national average. AIHW and Medicare data show a similar pattern.
77.5% of specialists and sub-specialists had their primary practice in a capital city
(64% of the female population), 7.2% in other metropolitan areas (7.5% of the
female population) and the remaining 15.3% in rural and remote centres (28.5% of
the female population).
Sub-specialties are generally located in the metropolitan areas and capital cities.
Only obstetrics and gynaecology ultrasound sub-specialists are represented in rural
centres.
Age Profile
The RACOG data indicated that the average age of the workforce was 51.1 years.
The largest five year age group was aged between 51 and 55 years (19.4%),
followed by the 46 to 50 year age group (17.5%), 7.0% (74) of the workforce was
8
AMWAC 1998.6
aged over 65 years and 32.0% (336) of the workforce was aged over 55 years.
Currently, 48.6% (510) of the total obstetrics and gynaecology workforce was aged
less than 50 years, and 17.2% (180) were aged over 60 years. The workforce is
predominantly (51.4%) over 50 years of age (539).
Tasmania has a noticeably older workforce with 29.2% (7) of specialists aged over
60 years. Victoria also has a higher proportion of specialists aged over 60 years,
19.0% (54). Queensland has the youngest age structure with 51.2% (87) of its
workforce aged under 50 years of age. The Northern Territory has a high proportion
of younger specialists, although the actual number is small, 50.0% (4).
Gender Profile
Women make up 15.1% of the total obstetrics and gynaecology workforce, and this
compares with women comprising 14.0% of all specialists.
In comparison to other specialties obstetrics and gynaecology appears to be one
speciality that is relatively attractive to women. As well as the proportion of women in
the specialty being above the national average for specialists, obstetrics and
gynaecology has the fifth highest proportion of female specialists of all specialties.
55.3% (156) of the current trainees in obstetric and gynaecology and 43.6% (17) of
the sub-specialist trainees are female; and this is one of the highest levels of female
participation in a specialist training program.
The largest proportion of female obstetrics and gynaecology specialists is in the 41
to 45 year age group (29.7%) followed by the 36 to 40 year age group (24.7%) and
the 46 to 50 year age group (15.2%).
Hours Worked
The average hours worked per week is estimated at 62.0; 42.6 hours per week were
spent in direct patient care and an additional 19.4 hours were worked on call.
In 1997, it is estimated specialists worked on average 62.0 hours per week, 64.0 for
males and 54.0 for females. For both males and females, those under 55 years of
age averaged around 62.5 hours per week; this declined to 54.1 hours for the 55 to
64 years age group and to 45.8 hours for 65 to 74 years age group. The highest
average hours worked per week were 71.2 hours by males aged 45 to 54 years and
for females 60.7 hours per week in the 35 to 44 age range.
Average hours worked increase with remoteness from a capital city and range from
an estimated 60.4 hours per week for capital city based specialists to 74.5 hours per
week for specialists located in remote areas. The proportion of the workforce on call
in small rural and remote areas is higher than in metropolitan and large rural centres.
9
AMWAC 1998.6
There is little difference in hours worked, practitioners on call and average age
between metropolitan and large rural centres.
Type of Practice
Of the 501 specialists who responded to the RACOG/AMWAC survey, 63.7% were
in a private practice and/or undertaking public hospital work; 15.8% were salaried in
a public hospital; 14.2% were in a private practice with no public hospital role; 2.2%
were public hospital salaried and in a private practice; 0.6% were salaried in private
hospital and in a private practice and/or undertake public hospital role; 0.5% had a
university appointment with a public hospital role.
Services Provided
The Working Party analysed obstetrics and gynaecology procedures performed on
private and public patients in Australian hospitals for the period 1993-94 to 1995-96.
The national hospital morbidity data is outlined in full in Appendix K but notable
trends are; between 1993-94 and 1995-96 the overall growth in gynaecological
procedures was 7.7% and the overall growth in obstetrical procedures was 11.8%,
for the same period.
Proportions of private versus public patients for given procedures varied widely
especially for gynaecological procedures. The overall proportion of gynaecological
procedures undertaken on private patients was 51.3%; this ranged from a high of
91.8% for the incision of vagina and cul-de-sac to a low of 33.8% for other bilateral
destruction or occlusion of fallopian tubes. Overall, obstetrics procedures were less
likely to be performed on private patients than were gynaecological procedures
(34.9% of obstetrical procedures compared with 51.3% of gynaecological
procedures were performed on private patients).
The Working Party also examined services attracting Medicare benefits and found
that over the ten year period, 1986-87 to 1996-97, all obstetrics and gynaecology
Medicare services provided by specialists increased by 27.2%. This represents a
growth of 2.7% per annum.
For gynaecological items there was an increase of 8.0% in the period 1986-87 and
1996-97 (0.8% growth per annum).
During the period 1995-96 and 1996-97, Medicare services provided by obstetrics
and gynaecology specialists for obstetric items increased by 42.7% (growth of
21.3% per annum over the two year period). Only the period 1995-96 to 1996-97
was examined because in 1995-96 ante-natal visits were included in the number of
services for the first time.
Confinement services provided by specialists in obstetrics and gynaecology
decreased by 33.0% in the period 1986-87 to 1996-97.
10
AMWAC 1998.6
In March 1998 there were 282 advanced trainees in obstetrics and gynaecology, the
bulk of whom are in years 1, 2 and 3 of the program (60.1%); reflecting the large
increase in annual intake from 1995 onwards.
Women represent 55.3% of current trainees.
In terms of the State/Territory distribution of trainees, the number in Queensland and
Western Australia is noticeably below those States population shares, and
conversely South Australia has a noticeably higher proportion of trainees compared
to population. The bulk of the trainees are located in New South Wales and Victoria
(57.2%/152). These two States share of trainees is roughly in proportion to their
respective population shares. Female trainees are well represented in each
State/Territory with the highest proportions in Queensland (63.8%), the Australian
Capital Territory (60.0%) and New South Wales (58.0%).
There has been a 34.3% increase in the number of trainees during the period 1992
to 1998. Trainee numbers increased dramatically in 1995, with a 35.6% increase on
the previous year. Female trainees increased by 85.7% during the period 1993 to
1998.
There were 39 sub-specialist trainees, the majority (79.5%) of whom were aged
under 40 years of age. Females represented 43.6% (17) of sub-specialist trainees.
Adequacy of the Current Obstetrics and Gynaecology Workforce
Overall, the Working Party concluded that there is some indication of a slight workforce
shortage, particularly when public hospital vacancies and consultation waiting times are
considered. Waiting times for a standard public patient were found to be noticeably
higher for patients in Queensland, Western Australia, Tasmania, South Australia and
Northern Territory. However, these regional shortages may relate more to
maldistribution of the workforce than any significant shortage in the workforce as a
whole, especially as the SPR data indicated that most States/Territories had an SPR
above the suggested benchmark.
The SPR data also showed that in capital cities/metropolitan areas all States/Territories
are currently well supplied with obstetrics and gynaecology specialists, with the
exception of the Northern Territory. In rural/remote areas South Australia and Western
Australia remain below the national rural/remote SPR.
Specialist (including sub-specialist) to Population Benchmarks
RACOG has indicated that an acceptable specialist (including subspecialist):population ratio (SPR) for females in urban areas is 1:10,000 and for rural
areas is 1:15,000. As the majority of the female population (64%) is situated in
capital cities/metropolitan areas the national ratio is skewed towards the urban areas
11
AMWAC 1998.6
and is estimated to be 1:12,500.

Examining the SPR by State and Territory and RRMA classification for the female
population age ranges indicated that in general capital city/metropolitan areas were
well supplied with specialists with the exception of the Northern Territory.
The distribution of specialists in rural/remote areas indicated that generally South
Australia, Western Australia, Queensland and Tasmania fall below the rural RACOG
SPR benchmark for the female population. RACOG has recommended that there
should ideally be at least two to four specialists (depending on the size of the
catchment population) resident in any one location which will allow appropriate cover
for those specialists who are in large remote areas. The above analysis of
rural/remote SPR levels indicates that these States/Territories may not have
appropriate cover.
The Working Party considered that where population size is below the necessary
critical mass to support a resident specialist, or there are no specialists interested in
establishing a practice in a community large enough to support a resident obstetrics
and gynaecology service, a regular visiting outreach service may become an
appropriate form of service delivery.
The average waiting time for a standard first consultation with a specialist in
obstetrics and gynaecology in his/her private rooms is 16.9 days (standard deviation
18.0) while public patients wait, on average, 31.9 days (standard deviation 48.4).
The waiting time in the Australian Capital Territory for a standard first consultation is
well above the average for both private and public patients.
For a serious condition, private patients wait less time (2.0 days, standard deviation
4.1) than do patients in public outpatient departments (7.1 days, standard deviation
18.5); with public patients in Queensland and Northern Territory waiting above
average times for urgent conditions.
The 1997 AMWAC survey of public hospital specialist vacancies found there were
17 obstetrics and gynaecology vacancies (13.5 full time equivalents). There were 6
(4.2 FTEs) vacancies in New South Wales, one (1 FTE) in Victoria, 8 (6.3 FTEs) in
Queensland, one (1 FTE) in South Australia and one (1 FTE) in Tasmania. There
were no vacancies in Western Australia. In addition, nine vacancies were filled by
TRDs; seven TRDs in New South Wales and one TRD in both Queensland and
Western Australia.
To gain a GP perspective on the adequacy of the specialist workforce, AMWAC
12
AMWAC 1998.6
surveyed the Divisions of General Practice. The survey found that 55.4% of
Divisions considered that a shortage of obstetrics and gynaecology specialists
existed in their area, with the remaining proportion predominantly of the view that
supply was about right. A greater proportion of rural divisions (61.5%) perceived the
supply of specialists to be inadequate than did Divisions located in urban areas
(50.0%).
Projections of Requirements
Population
Over the next ten years, the total Australian female population is expected to
increase at an annual rate of 1.1% per annum. During the same period the female
population greater than 15 years will increase approximately by 1.1% per annum,
those aged 15-49 years will increase approximately 0.2% per annum, those aged
greater than 25 years will increase approximately 1.0%per annum and those ages
over 49 years will increase by 2.7% per annum.
Birth Rate
There has been a growth in births in Australia from 243,408 live births in 1986 to
253,834 in 1996, this represents a growth of 4.3%, or 0.4% per annum. Future
projections indicate that birth rates will remain constant.
Fertility Rate
The total fertility rate since 1992 (1.894) has steadily declined, with the fertility rate
for registered births at 1.796 in 1996, the lowest rate on record. The fertility rate is
considered to be more likely to fall or remain stable in the longer term, and the age
distribution will continue to change in favour of ages over 30 years. It can be
assumed that as the mean age of women giving birth to their first child in Australia
increases it will in turn increase the likelihood of increased demand for specialist in
obstetrics and gynaecology.
Medicare and ICD-9-CM Data Trends
Medicare obstetrics and gynaecology services provided by obstetricians and
gynaecologists have shown a 2.7% per annum growth over the period 1986-87 to
1996-97.
ICD-9-CM data on obstetrics and gynaecology have indicated that for gynaecological
procedures there will be overall growth of 14.0% over the next 20 years (1998-2018)
or 0.7% per annum. For obstetrical procedures it is forecasted to rise by only 2.2%
or by 0.1% per annum in the same period.
The Working Party concluded that the birth rate provided the best indicator of likely
future obstetrics and gynaecology services requirements, that is requirements
growth of an estimated 0.4% per annum. This projection trend is the mid point of all
the indicators examined. It is lower than most of the population trends, but higher
13
AMWAC 1998.6
than the fertility rate and the incidence of cancer trend. It is actually close to the
trend in growth in obstetrics and gynaecology ICD-9-CM national hospital morbidity
data
Projections of Supply
The average expected age of retirement from the workforce was 63 years.
Examining the age and sex distribution of the specialist workforce shows that the
majority (52.7%) of the workforce is aged over 50 years, 32.0% of the workforce is
aged 55 years and over and 18.0% are aged over 60 years. Assuming the average
retirement age from the RACOG/AMWAC survey of 63 years, it can be estimated
that there could be approximately 200 (21%) specialists intending to retire in the next
five years.
RACOG expects trainee graduations over the next seven years to be: 45 in 1998, 21
in 1999, 50 in 2000, 47 in 2001, 57 in 2002, 49 in 2003 and 42 in 2004; that is an
average of 48 graduates per year (excluding 1999 graduates).
It is expected that the proportion of women in the workforce will increase; given the
continuing increase in the number of female trainees. Women represent 15.5% the
current total workforce, but 55.3% of trainees. In addition, of the 336 specialists aged
55 years and over, only 21 are female.
The expected lifetime hours worked by a female obstetrics and gynaecology
specialist has been estimated at 74.1% of that of a male. In conducting the
projection analysis, the expected supply has been adjusted to account for increasing
female participation and for the expected lower lifetime workforce contribution.
Contribution of Services by Non-specialist Providers
One of the features of obstetrics and gynaecology is the scope for non specialist
providers to provide at least some of the services in obstetrics and minor
gynaecological procedures. There are no definitive data sources that enable the
level of substitution to be assessed, however Medicare data does provide an
indication of the number of services provided by specialists and non specialists.
When private services alone are considered the majority of Medicare obstetrics and
gynaecology services are provided by specialist obstetricians and gynaecologists. In
1996-97, 86.5% of confinements were provided by
obstetricians and
gynaecologists, 57.2% of obstetric items and 75.3% of gynaecological items. There
has been a fall of 5.6 percentage points in the number of obstetric services provided
by a GP during the period 1995-96 and 1996-97. Similarly, obstetrics services
provided by specialists increased by 5.7 percentage points and confinement items
provided by specialists increased by 1.5 percentage points.
14
AMWAC 1998.6
In terms of obstetrics it is clear that there has been a relative decline in the provision
of privately provided services by GPs against the backdrop of a falling number of
private deliveries overall. In 1986, 23.1% of private deliveries were performed by
GPs, in 1996-97, the proportion was down to 13.3%, in other words, a dominant
trend has been declining involvement of GPs in private obstetrics. As a consequence
the proportion of private deliveries undertaken by obstetrics and gynaecology
specialists has risen markedly, to the point that nearly 90% of all private deliveries
are undertaken by specialists.
In terms of States/Territories, Queensland and Western Australia show GP
involvement above the national average. In antenatal care South Australia and
Northern Territory GP involvement is also above the national average, as is the
involvement of GPs in the management of labour in Tasmania and the Northern
Territory.
States/Territories with GP involvement below the national average are New South
Wales, Tasmania and the Australian Capital Territory. These figures indicate that
there is a predominant role taken by GPs in providing obstetrics and gynaecology
services in some of the less populous States/Territories, much of which is likely to be
in provincial and rural/remote areas.
Balancing Supply Against Requirements
A balance in supply to match a continued growth rate in the requirement indicators
of 0.4% per annum can be achieved by ensuring the same number of graduates
currently entering the six year program is maintained; that is a trainee intake of 58
per year.
If trainee intakes remain at around 58 per year, it is expected that there will be no
significant shortfall emerging in the workforce. Notional shortages are expected to
peak at 2.9% in 2002 but for requirements and supply to move back towards
balance thereafter. It is projected that there will only be 1.6% shortfall in 2008.
Ideally trainee intake should be around 58 per year so that no significant shortfall
emerges in the workforce. However, RACOG has indicated that the initial intake of
58 trainees per year may not be achievable as there are limited potential training
positions currently available and an already stretched resource of trainers.
Maintenance of trainee intake at this level could also impact on trainees obtaining
the necessary accumulated training experience. Accordingly, to accommodate this
concern several scenarios based on trainee intake ranging from 50 per year to 58
per year were examined. Notional shortfalls range from a near balanced scenario
with a trainee intake of 58 per year to an estimated shortfall of 3.6% with a trainee
intake of 50 per year.
15
AMWAC 1998.6
In recognition of RACOGs concern the Working Party has recommended that an

intake of 55 trainees per year may be a more practical target to reach. A trainee
intake of 55 per year, will produce an estimated workforce shortfall of 2.1% in 2009.
Of course this does not address the issue of maldistribution of the workforce and in
this respect it will be necessary for RACOG and State/Territory health departments
to make internal adjustments to the distribution of training positions.
The Working Party recommends that training positions should be increased
proportionately less in the comparatively well endowed state of South Australia, and
to a lesser extent Victoria, although it needs to be remembered that Victoria has a
significant proportion of older specialists. This is also the case in New South Wales.
In particular, emphasis needs to be given to increasing training positions in New
South Wales, Western Australia and Queensland.
Given the sensitivity of the assumptions in the projection modelling, it will be
important that obstetrics and gynaecology requirements and supply projections be
monitored regularly so that they can be amended if new trends emerge. The
Working Party recommends that a review of the specialist obstetrics and
gynaecology workforce be undertaken before the level of trainee intake for 2003 is
determined, that is by the end of 2000 to allow sufficient time to recruit the 2003
intakes. In this context, it will also be important for AMWAC to continue to monitor
the trend in the numbers of non specialist providers.
It should also be noted that whilst RACOG has recently introduced a compulsory six
month rural training placement for trainees, in an effort to improve awareness of
rural practice, this scheme will need the continued support of State/Territory health
departments in terms of funding and support of suitable rural training positions.
The Working Party would also like the Commonwealth and State/Territory health
departments to consider the establishment of rural cadetships aimed at providing
financial assistance to those training in their last year and are interested in remaining
and establishing a rural practice. This process coupled with the compulsory
experience to rural practice through the training program may help to alleviate some
of the geographical maldistribution inherent in the workforce. In the first instance the
Commonwealth Department of Health and Family Services and RACOG should
jointly examine the feasibility of such a scheme.
16
AMWAC 1998.6
RECOMMENDATIONS
The Working Party recommends:
1.
There be an increase in the number of funded obstetrics and gynaecology

training positions to maintain trainee intake during the period 1999 to 2002 at 55
per year.
2.
That State and Territory health departments undertake negotiations with the
RACOG to ensure intake numbers for first year trainees remain constant at 55
per year to 2002 and distributed as shown below.
Distribution of obstetrics and gynaecology first year advanced trainee positions, by
State/Territory, 1999 to 2002
State/Territory
1997
1998
1999
actual intakes
2000
2001
2002
required intake
NSW
18
14
20
20
20
20
Victoria
12
10
14
14
13
12
Queensland
11
11
11
11
South Australia
Western Australia
Tasmania
ACT
Northern Territory*
49
42
55
55
55
55
Australia
* Trainees to the Northern Territory are on a rotational basis from other States
Source: AMWAC
3.
State/Territory based obstetrics and gynaecology services working groups,

comprising RACOG and State/Territory department of health representatives, be
organised to oversee the funding and establishment of any new training
positions.
4.
That obstetrics and gynaecology requirements and supply projections be

monitored regularly so that they can be amended if new trends emerge, and that
the specialist obstetrics and gynaecology workforce be reviewed before the level
of trainee intake for 2003 is decided, that is at the end of 2000.
17
AMWAC 1998.6
5.
That this monitoring be coordinated by RACOG and AMWAC and the results
incorporated into the AMWAC annual report to AHMAC. AMWAC will provide all
necessary support.
6.
AMWAC also to continue to monitor the trend in the numbers of non specialist
obstetric and gynaecology providers (general practitioners and midwives).
7.
The RACOG and the Commonwealth Department of Health and Family Services
examine the feasibility of establishing a rural obstetric and gynaecology graduate
cadetship scheme to encourage graduates from the obstetrics and gynaecology
training program to consider rural practice.
18
AMWAC 1998.6
DESCRIPTION
WORKFORCE
OF
THE
CURRENT
OBSTETRICS
AND
GYNAECOLOGY
As discussed in the introduction, there are a variety of data sources on the numbers,
attributes and distribution of obstetrics and gynaecology specialists and sub-specialists
in Australia. While each of these data collections has some deficiencies, it is possible to
piece together a reasonably accurate and up-to-date profile of the workforce.
In establishing the profile of the current obstetrics and gynaecology and sub-specialty
workforce the Working Party defined:
the number of practising obstetrics and gynaecology specialists;
the distribution of the workforce;
the age and gender profiles of the workforce;
the hours worked; and
the services provided.
The Number of Practising Obstetrics and Gynaecology Specialists in Australia
Specialists in obstetrics and gynaecology are generally Fellows of the Royal Australian
College of Obstetricians and Gynaecologists (FRACOG). Fellows may practice as
obstetricians, gynaecologists, or both, or in the sub-specialities of maternal fetal
medicine, uro-gynaecology, obstetrical and gynaecological ultrasound, gynaecological
oncology and reproductive endocrinology and infertility.
The Working Party estimated that in March 1998 the current size of the practising
obstetrics and gynaecology workforce was 1,049 which includes both specialists and
sub-specialists. This figure was provided by RACOG, and includes members who
identified themselves as being a FRACOG and are registered under the National
Specialist Qualification Advisory Committee as a specialist or sub-specialist in obstetrics
and gynaecology.
Of the 1,049, ninety eight (9.3%) were identified as sub-specialists. It is important to
note, however, that this is not a strict division of the area of practice because many
specialists may provide sub-speciality services and sub-specialists may provide general
obstetrics and gynaecology services. RACOG records further show that 502 specialists
consider their predominant clinical practice to be in obstetrics (although time was also
spent in gynaecology) and 79 Fellows consider their predominant area of clinical
practice to be in gynaecology. 370 Fellows have indicated to the College that they
spend roughly the same amount of time in obstetrics and gynaecology.
Of the practitioners who are sub-specialists, 10 are maternal fetal medicine specialists,
13 uro-gynaecology specialists, 23 obstetrical and gynaecological ultrasound
specialists, 24 gynaecological oncology specialists and 28 reproductive endocrinology
and infertility specialists. More detailed data on each of the sub-specialist workforces is
provided in Part B of the report.
19
AMWAC 1998.6
Distribution of the Obstetrics and Gynaecology Workforce

State/Territory Distribution
The distribution of the total specialist obstetrics and gynaecology workforce is shown in
Table 1.
Using three data sources (RACOG, AIHW and Medicare) the total specialist obstetrics
and gynaecology to population ratio (SPR) is estimated to range from 1:6,954 to 1:7,547
or (13.3 to 14.4 specialists per 100,000 female population).
RACOG data estimates the national SPR to be 1:6,954 female population. The RACOG
data shows Victoria and South Australia have the highest SPR and Tasmania and the
Northern Territory the lowest SPRs. Other States/Territories, with a SPR better than the
national average are New South Wales and the Australian Capital Territory. The SPRs
in Queensland and Western Australia are noticeably lower than the national average.
AIHW and Medicare data show a similar pattern.
Table 2 shows the geographic distribution for the total workforce, using 1998 RACOG
data. Overall, 77.5% of the workforce had their primary practice in a capital city (64% of
the female population), 7.2% in metropolitan areas (7.5% of the female population) and
the remaining 15.3% in rural/remote areas (28.5% of the female population) - (8.5% in a
large rural centre, 3.4% in a small rural centre, 2.5% in other rural areas and 0.9% in
remote areas).
The data from the 1995 AIHW survey indicates a similar distribution pattern; 83.7% of
specialists had their main job in a capital city or other major urban area, 9.1% in a large
rural centre, 4.3% in a small rural centre, 2.3% in other rural areas and 0.6% in remote
areas.
20
AMWAC 1998.6
Table 1: Obstetrics and gynaecology specialists/sub-specialists to population, by State/Territory

State/
Territory
O&G spec.
and
sub-spec.
% of total O&G
spec. and
sub-spec.
% of Australian
female
a
pop. >15 years
O&G
SPR
O&G per
100,000 pop.
Total number of specialists and sub-specialists (RACOG 1998)

NSW
361
34.4
34.0
1:6,879
14.5
Vic.
284
27.1
25.3
1:6,498
15.4
Qld
170
16.2
17.9
1:7,694
13.0
SA
92
8.8
8.2
1:6,515
15.3
WA
92
8.8
9.4
1:7,465
13.4
Tas.
24
2.3
2.6
1:7,852
12.7
0.8
0.9
1:7,820
12.8
18
1.7
1.7
1:6,777
14.8
1,049
100.0
41.1
1:6,954
14.4
NT
ACT
Australia
Total number of specialists and sub-specialists (AIHW 1995)
1:7,904
12.7
26.5
25.3
1:7,035
14.2
165
16.9
17.9
1:7,791
12.8
SA
91
9.1
8.3
1:6,547
15.3
WA
89
8.9
10.8
1:8,699
11.5
Tas.
25
2.6
2.6
1:7,460
13.4
NT
11
1.1
0.4
1:2,730
35.8
ACT
26
2.7
1.7
1:4,561
21.9
974
100.0
100.0
1:7,371
13.6
NSW
309
31.7
Vic.
258
Qld
Australia
34.0
Total number of specialists and sub-specialists (Medicare 1995-96)

NSW
339
35.0
34.0
1:7,325
13.7
Vic.
264
27.3
25.3
1:6,990
14.3
Qld
147
15.2
17.9
1:8,898
11.2
SA
77
8.0
8.2
1:7,787
12.8
WA
85
8.8
9.4
1:8,079
12.4
Tas.
2.6
NT
0.9
ACT
1.7
968
100
100
1:7,537
13.3
Australia
Notes: a - 1996 ABS female population figures; b - specialists whose main specialty of practice is obstetrics and
gynaecology; c - 1995 ABS female population figures; * - number less than three. Source: RACOG & AIHW
21
AMWAC 1998.6
Table 2: Distribution of the total obstetrics and gynaecology workforce, by State/Territory and
geographic location (RACOG data), 1998
Total
% of
Aust
% capital
city
% other
metro
% large
rural
centre
% small
rural
centre
% other
rural
centre
%
remote
NSW/ACT
379
36.1
76.5
10.6
7.1
4.8
1.1
0.0
Vic
284
27.1
82.0
3.2
6.2
3.2
4.9
0.0
Qld
170
16.2
63.5
12.9
21.8
0.6
0.6
0.6
SA
92
8.8
91.3
..
2.2
1.1
5.4
0.0
WA
92
8.8
85.9
5.4
..
4.3
0.0
4.3
Tas
24
2.3
66.7
..
16.7
12.5
4.2
0.0
NT
0.8
37.5
..
0.0
..
12.5
50.0
1,049
100.0
77.5
7.2
8.5
3.4
2.5
0.9
State/
Territory
Australia
Notes: . . - not applicable

Source: RACOG 1998
Age Profile
The RACOG data indicated that the average age of the workforce was 51.1 years. The
largest five year age group was aged between 51 and 55 years (19.4%), followed by the
46 to 50 year age group (17.5%), while, 7.0% (74) of the workforce was aged over 65
years and 32.0% (336) of the workforce was aged over 55 years (Table 3).
Table 4 provides a summary of the workforce by major age categories. It shows that for
Australia, 48.6% (510) of the total obstetrics and gynaecology workforce was aged less
than 50 years, and 17.2% (180) were aged over 60 years. The workforce is
predominantly (51.4%) over 50 years of age (539).
Tasmania has a noticeably older workforce with 29.2% (7) of specialists aged over 60
years. Victoria also has a higher proportion of specialists aged over 60 years, 19.0%
(54), than the national average. Queensland has the youngest age structure with 51.2%
(87) of its workforce aged under 50 years of age. The Northern Territory also has a high
proportion of young specialists, although the actual number is small, 50.0% (4).
The 1995 AIHW data indicated that the average age of the workforce was 51.1 years,
with 103 specialists (10.5%) aged 65 years and over (Appendix C).
22
AMWAC 1998.6
Table 3: Age profile of the total obstetrics and gynaecology specialist workforce, by State/Territory and
gender (RACOG data), 1998
State/
Terr.
31-35
yrs
36-40
yrs
41-45
yrs
46-50
yrs
51-55
yrs
56-60
yrs
61-65
yrs
66-70
yrs
71 +
yrs
Total
Male
NSW
12
26
46
52
77
48
29
22
313
Vic.
19
30
39
52
35
24
15
233
Qld.
18
15
34
22
29
13
10
150
SA
13
15
13
11
73
WA
15
17
15
76
Tas.
23
ACT
16
NT
33
81
112
160
190
148
99
57
11
891
Aust.
Female
NSW
13
14
48
Vic.
12
17
51
Qld.
20
SA
19
WA
16
Tas.
ACT
NT
14
39
47
24
13
158
Aust.
Total
NSW
16
39
60
60
80
49
32
22
361
Vic.
13
31
47
46
56
37
35
18
284
Qld
24
19
37
25
31
13
10
170
SA
10
15
15
17
15
11
92
WA
10
10
19
17
16
92
Tas.
24
ACT
18
NT
Aust.
47
120
159
184
203
156
106
61
13
1,049
% total
4.5
11.4
15.2
17.5
19.4
14.9
10.1
5.6
1.2
100.0
29.8
32.5
29.6
13.0
6.4
5.1
6.6
6.6
15.4
15.1
% female
Source: RACOG 1998
23
AMWAC 1998.6
Table 4: Age profile of the total obstetrics and gynaecology specialist workforce, by State/Territory,
gender and major age group (RACOG data), 1998
State/Terr.
NSW
Vic
Qld
SA
WA
Tas
NT
ACT
Aust
Number of specialist obstetricians and gynaecologists

Male
under 50 years
136
96
72
31
30
10
386
51-60 years
125
87
51
28
32
338
52
50
27
14
14
167
313
233
150
73
76
23
16
891
over 60 years
Total
Female
under 50 years
39
41
15
14
13
124
51-60 years
21
over 60 years
13
48
51
20
19
16
158
Total
Total
under 50 years
175
137
87
45
43
11
510
51-60 years
129
93
56
32
33
359
57
54
27
15
16
180
361
284
170
92
92
24
18
1,049
over 60 years
Total
Percentage
Male
under 50 years
43.5
41.2
48.0
42.5
39.5
43.5
42.9
50.0
43.3
51-60 years
40.0
37.3
34.0
38.4
42.1
26.1
42.9
37.5
37.9
over 60 years
16.5
21.5
16.0
19.1
18.4
30.4
14.2
12.5
18.7
Female
under 50 years
51-60 years
over 60 years
81.3
80.4
75.0
73.7
81.3
100.0
100.0
0.0
78.5
8.3
11.8
25.0
21.1
6.2
0.0
0.0
50.0
13.3
10.4
7.8
0.0
5.2
12.5
0.0
0.0
50.0
8.2
Total
under 50 years
48.5
48.2
51.2
48.9
46.7
45.8
50.0
44.4
48.6
51-60 years
35.7
32.7
32.9
34.8
35.9
25.0
37.5
38.9
34.2
over 60 years
15.8
19.1
15.9
16.3
17.4
29.2
12.5
16.7
17.2
% Female
13.3
18.0
11.8
20.7
17.4
4.2
12.5
11.1
15.1
Source: RACOG 1998
24
AMWAC 1998.6
With respect to the specialist workforce of 951, the data shows that the largest five year
age group is the 51 to 55 year age group (19.2%), followed by the 46 to 50 year age
group (16.8%), and that 7.6% (72) of the workforce were aged over 65 years of age.
The youngest specialist was 33 and the oldest was 76 with an average age of 51.5
years. The youngest obstetrician was 35 years and the oldest was 77 years with a mean
age of 45.4 years. The youngest gynaecologist was 39 years and the oldest was 76
years with a mean age of 47.9 years.
Table 6 provides a summary of specialists by major age categories. It shows that for
Australia, 47.2% (449) of specialists was aged less than 50 years, and 18.0% (171)
were aged over 60 years. The specialist workforce is predominantly (52.8%) over 50
years of age (502).
Table 5: Age profile of obstetrics and gynaecology specialists, by State/Territory and gender
(RACOG data), 1998
State/Terr.
Sex
51-55
yrs
56-60
yrs
61-65
yrs
66-70
yrs
NSW
47
68
45
27
22
279
12
44
17
27
30
46
35
31
13
208
12
15
49
Queensland M
17
13
31
22
29
12
10
143
19
11
14
11
10
67
17
11
15
12
65
14
21
14
Victoria
South Aust.
West. Aust.
Tasmania
North. Terr.
ACT
Australia
31-35
yrs
36-40
yrs
41-45 46-50
yrs
yrs
11
21
37
12
71+ Total
yrs
31
71
96
137
171
140
92
55
11
804
14
37
40
23
12
147
Total
45
108
136
160
183
148
99
59
13
951
% Total
4.7
11.4
14.3
16.8
19.2
15.6
10.4
6.2
1.4 100.0
% Female
31.1
Source: RACOG 1998
34.3
29.4
14.4
6.6
5.4
7.1
25
6.8 15.4
15.5
AMWAC 1998.6
Table 6: Age profile of obstetrics and gynaecology specialists, by State/Territory, gender and major
age group, 1998
State/Terr.
Sex
under 50 years
116
82
66
29
24
335
35
39
14
13
11
114
113
81
51
25
27
311
20
50
45
26
13
14
158
13
257
162
84
79
22
16
951
51-60 years
over 60 years
Total
NSW
323
Vic
Qld
SA
WA
Tas
NT
ACT
Aust
Source: RACOG 1998
Gender Profile
Women make up 15.1% of the total obstetrics and gynaecology workforce, and this
compares to women comprising 14.0% of all specialists.
In comparison to other specialties obstetrics and gynaecology appears to be one
speciality that is relatively attractive to women. As well as the proportion of women in
the specialty being above the national average for specialists, obstetrics and
gynaecology has the fifth highest proportion of female specialists of all specialties
(AIHW 1997). In addition, 55.3% (156) of the current trainees in obstetric and
gynaecology and 43.6% (17) of the sub-specialist trainees are female; and this is one of
the highest levels of female participation in a specialist training program (MTRP 1997).
The largest proportion of female obstetrics and gynaecology specialists is in the 41 to 45
year age group (29.7%) followed by the 36 to 40 year age group (24.7%) and the 46 to
50 year age group (15.2%). Males represent 84.9% of the total workforce, with the
largest proportion of male specialists/sub-specialists in the 51 to 55 year age group
(21.3%) followed by the 46 to 50 year age group (18.0%) and the 56 to 60 year age
group (16.6%).
The upward trend in female participation will need to be monitored as it has implications
for the future available workforce. Previous AMWAC studies have shown that female
specialists have a lower lifetime workforce participation than male specialists. The
AMWAC/AIHW report on female participation in the medical workforce estimated the
lifetime workforce participation of female obstetrics and gynaecology specialists at 74%
of the male lifetime hours worked (AMWAC/AIHW 1996). However, feedback received
from RACOG indicated that there is a possibility that the younger cohort of females
entering the profession intend to provide a longer lifetime contribution than their
predecessors. Increased levels of female participation are also likely to have an effect
26
AMWAC 1998.6
on patterns of practice.
Hours Worked
The data used in this section have been derived from the 1997 RACOG/AMWAC
survey, comparative data from the 1995 AIHW medical labour force survey are provided
in Appendix C.
The level of active supply in any medical workforce is affected by the participation rate
of practitioners, in terms of hours worked. Accordingly, obstetrics and gynaecology
specialists working different hours can be converted to a standard estimate of
productivity by the number of hours worked. This approach is an important aspect of the
projection analysis used later in this report.
Table 7 details the average hours provided by the total workforce. The average hours
worked per week is estimated at 62.0; 42.6 hours per week were spent in direct patient
care and an additional 19.4 hours were worked on call.
It is estimated that specialists worked a total of 2,747,138 hours in 1997; of these hours
1,869,458 hours were in direct patient care. This equates to 37,654 hours per 100,000
female population (>15 years) in total hours worked, with the provision of hours worked
per 100,000 population significantly above the average in Victoria and South Australia,
and below the average in Western Australia and the Australian Capital Territory.
27
AMWAC 1998.6
Table 7: Specialists and sub-specialists in obstetrics and gynaecology average hours worked per week and
annual labour supply hours, by State/Territory, 1998
State/Terr.
NSW
Vic
Qld
SA
WA
Tas
ACT
NT
Total
Total hours worked

Ave. hours
per week
58.7
70.8
66.2
64.7
49.5
52.2
48.9
57.0
62.6
Annual hours
worked
a
>000)
855.9
846.8
493.3
255.9
188.9
52.2
35.9
18.4
2,747.1
Hours worked
per 100,000
female pop.
34,470
45,885
37,715
42,701
27,521
29,314
29,524
29,319
37,654
Direct patient care hours worked

Ave. hours
per week
41.9
43.2
44.7
42.1
41.3
35.8
36.4
52.0
42.6
Annual hours
worked
a
(>000)
610.9
516.7
333.1
166.5
157.7
37.9
26.8
16.7
1,869.5
Hours worked
per 100,000
female pop.
24,604
27,998
25,467
27,786
22,962
20,104
21,977
26,748
25,624
Hours on call worked

Ave. hours
per week
17.6
21.1
21.7
24.7
13.0
18.2
6.6
26.7
19.4
Annual hours
worked
a
(>000)
256.0
252.3
161.7
97.7
49.6
19.3
4.8
8.6
851.3
Hours worked
per 100,000
female pop.
10,335
13,674
12,363
16,301
7,228
10,221
3,984
13,734
11,669
Hours on call not worked

Ave. hours
per week
63.0
61.3
64.3
66.8
58.9
82.2
45.6
84.0
63.1
Annual hours
worked
a
(>000)
918.7
733.1
479.2
264.3
224.9
86.9
33.6
27.1
2,769.1
Hours worked
per 100,000
female pop.
36,995
39,728
36,633
44,087
32,747
46,161
27,532
43,208
37,955
Female pop. >

15 years
(>000)
2,483.2
1,845.4
1,308.0
599.4
686.7
188.4
121.9
62.6
7,296.6
317
260
162
86
83
23
16
954
Specialists
28
AMWAC 1998.6
Note: a - calculated as average hours multiplied by persons multiplied by 46 weeks per year . Source: RACOG
29
AMWAC 1998.6
Table 8 details the average hours provided by the total workforce in obstetrics and
gynaecology by gender and age. In 1997, specialists worked on average 62.0 hours per
week, 64.0 for males and 54.0 for females. For both males and females, those under 55
years of age averaged around 62.5 hours per week; this declined to 54.1 hours for the
55 to 64 years age group and to 45.8 hours for 65 to 74 years age group. The highest
average hours worked per week were 71.2 hours by males aged 45 to 54 years and for
females 60.7 hours per week in the 35 to 44 age range.
Table 8: Specialists in obstetrics and gynaecology average hours and annual hours worked, by
gender and age group, 1998
Gender
25-34
yrs
35-44
yrs
45-54
yrs
55-64
yrs
65-74
yrs
75 yrs &
over
Total
Total hours worked

Male
51.9
70.5
71.2
54.9
47.1
10.0
64.0
Female
48.7
60.7
44.8
30.0
10.0
0.0
54.0
Total
51.0
67.1
69.4
54.1
45.8
10.0
62.0
70.4
762.4
1,209.9
652.0
69.5
1.4
2,733.9
Annual hrs worked (>000)

Male
37.9
45.4
47.7
38.2
31.0
10.0
43.1
Female
40.5
40.8
35.1
33.5
nr
0.0
39.0
Total
38.4
43.8
46.7
38.0
31.0
10.0
42.6
52.9
497.6
814.2
457.9
47.1
1.4
1,869.5

Male
67.9
59.7
67.1
63.6
51.5
0.0
63.7
Female
50.0
54.1
59.7
102.7
0.0
0.0
58.6
Total
65.9
57.9
66.6
64.8
51.5
0.0
63.1
90.9
657.6
1,161.1
780.9
78.2
0.0
2,769.1

Male
Female
Total
13.3
21.6
18.7
15.8
26.7
0.0
18.6
5.0
2.5
25.4
1.5
0.0
0.0
21.9
12.3
21.9
19.1
15.6
26.7
0.0
19.4
16.9
248.8
332.9
188.0
40.5
0.0
851.4
Note: a - calculated as average hours multiplied by persons multiplied by 46 weeks per year
Source: RACOG and RACOG/AMWAC Survey 1997
30
AMWAC 1998.6
There were 10% (50) specialists who worked less than 35 hours per week and 14% (71)
who reported working 80 hours per week or more.
By way of comparison the AIHW Labour Force survey found that in 1995 specialists
worked on average 55.0 hours per week, 55.7 for males and 49.3 for females. Those
under 55 years of age averaged around 60 hours per week, and this declined to 49.5
hours for 55 to 64 years age group, 31.7 hours for 65 to 74 years age group and 27.3
hours for those aged 75 years or more. The highest average hours worked per week
were 54.0 hours by males aged 45 to 54 years. There were 13.5% (132) specialists who
worked less than 35 hours per week and 12.3% (119) who reported working 80 hours
per week or more.
Table 9 shows the average hours worked by location and reveals several interesting
trends:
average hours worked increase with remoteness from a capital city and range
from an estimated 60.4 hours per week for capital city based specialists to 74.5
hours per week for specialists located in remote areas;
the hours worked on call are higher in rural and remote areas, and this appears
as the main reason for the higher average hours per week in these areas;
the proportion of the workforce on call in small rural and remote areas is higher
than in metropolitan and large rural centres;
specialists in small rural centres and remote areas are, on average, three to five
years older than their metropolitan counterparts; and
there is little difference in hours worked, practitioners on call and average age
between metropolitan and large rural centres.
Table 9: Hours worked by specialists in obstetrics and gynaecology, by geographic location, 1997
Major
urban
centre
Large
rural
centre
Small
rural
centre
Other
rural
area
Remote
Total
Total
60.4
60.7
62.3
73.8
74.5
62.6
Direct patient care
41.9
43.8
45.7
45.7
60.0
42.5
17.1
20.1
39.1
20.2
27.0
19.4
Hours on call
60.3
59.1
64.9
59.6
66.5
63.1
Per cent practitioners on call (%)
81.7
80.0
93.3
100.0
100.0
80.8
50
50
53
49
55
51
82.3
9.6
3.9
2.3
1.9
100.0
Hours worked
Average age (years)

% of the specialist workforce
Source: RACOG and RACOG/AMWAC Survey 1997
31
AMWAC 1998.6
Similar results were found with the AIHW data (Table C5) which showed that 63.6%
reported being on call . The proportion on call and the number of hours on call rose with
distance away from a metropolitan area, with remote area specialists reporting working
100% on call hours. The average hours worked varied by region, increasing from 46.1
hours a week in urban areas to to 68.3 hours a week in remote areas.
Intentions to Change Hours Worked
55% (263) of respondents of the RACOG/AMWAC survey indicated that they planned to
change the hours they work, with 43.1% (207) of respondents anticipating their work
hours to decrease, 12.2% (60) expecting their work hours to increase and 44.7% (214)
of respondents expected their hours to remain the same (n=476).
Table B14 indicates the change in hours worked by State/Territory, with the most
significant anticipated change being that of the obstetric and gynaecology workforce in
New South Wales, with 50% (75) of practitioners indicating an anticipated a reduction in
their work over the next five years.
Significant associations were observed between respondents indicating an anticipated
reduction in the hours over the next five years and gender, geographic location, rising
medical indemnity insurance, lifestyle preferences, family considerations, health
considerations and retirement.
A significant association was observed between intention to increase hours worked and
an expected increase in demand for obstetrics and gynaecology services (p<0.01).
Other reasons cited by respondents that would increase the hours worked by specialists
over the next five years included: financial incentives and children beginning school.
Practice Profiles
Of the 501 specialists who responded to the RACOG/AMWAC survey, 63.7% were in a
private practice and/or undertaking public hospital work; 15.8% were salaried in a public
hospital; 14.2% were in a private practice with no public hospital role; 2.2% were public
hospital salaried and in a private practice: 0.6% were salaried in private hospital and in a
private practice and/or undertake public hospital role; 0.5% had a university appointment
with a public hospital role.
The proportion reporting employment in public hospitals was much higher in New South
Wales (32.9%) and lower (1.3%) in Tasmania. Private practice employment was highest
in the New South Wales (20.0%) and lowest in the Northern Territory (1.4%) (Table
B10, Appendix B).
The majority (67.1%) of respondents indicated they worked as solo-specialists; 20.8%
worked with other obstetricians and gynaecologists and 3.2% worked with a multidisciplinary group (Table B8 in Appendix B).
32
AMWAC 1998.6
Services Provided
Obstetrics and gynaecology services in Australia are provided through Medicare and
other insurance arrangements in fee for service practice and through the government
funded public hospital system. Detailed service specific data on medical services which
attract Medicare benefits is available for twelve years. Public and private hospital
casemix activity data is only available for the last few years.
It is also important to note that there are data limitations in determining the number of
services provided by specialists in obstetrics and gynaecology, this is due in part to the
substitution of services by other providers, particularly GPs and midwives (see later
discussion on substitution of services); and in this respect there is no definitive national
data set available to separate the number of services contributed by each provider. In
addition, Medicare data only covers private practice billing activity; with only a minority
of the population with private health insurance (approximately 30% in 1998),
consequently the Medicare data needs to be interpreted with this shortcoming in mind.
One advantage of the Medicare data, however, is that it can be separated into services
provided by specialists and those provided by non-specialists.
National Hospital Morbidity Data
One of the key sources of services data is AIHWs National Hospital Morbidity data. The
Working Party analysed obstetrics and gynaecology procedures performed on private
and public patients in Australian hospitals for the period 1993-94 to 1995-96. The data is
outlined in full in Appendix I but notable trends are:
Between 1993-94 and 1995-96 the growth in gynaecological procedures was 7.7%
(Table I9);
However, the growth in individual procedures varied widely eg growth in
salpingotomy and salpingostomy procedures was 38.7% (Table I9);
The overall growth in obstetrical procedures was 11.8% from 1993-94 to 1995-96.
Procedures with considerably more than the overall growth included medical
induction of labour which showed 65.3% growth (Table I10);
Proportions of private versus public patients for given procedures varied widely
especially for gynaecological procedures (Tables I1 to I2, I11 to I12).
The overall proportion of procedures undertaken on private patients was 51.3%. This
ranged from a high of 91.8% for the incision of vagina and cul-de-sac to a low of
33.8% for other bilateral destruction or occlusion of fallopian tubes (excluding those
procedures with low incidence of less than 1,000) (Table I11);
Overall, obstetrics procedures were less likely to be performed on private patients
than were gynaecological procedures (34.9% of obstetrical procedures compared
with 51.3% of gynaecological procedures were performed on private patients, Tables
I11 and I12);
The proportions of specific obstetrical procedures performed on private patients
varied less than for gynaecological procedures. They ranged from a high of 50.2%
for forceps rotation of fetal head to a low of 15.0% for other intrauterine operations
33
AMWAC 1998.6
on fetus and amnion (excluding those with low incidence of less than 1,000) (Table
I12);
Analysis of age profile data is limited to 1995-96 data:
Gynaecological procedures were more commonly performed on 25 to 34 year olds
than other age groups (30.9% were undertaken on females in this age group, Table
I5);
Young aged females (0-24 years) and older aged females (65 years and over) were
less likely to undergo gynaecological procedures as private patients. About 39% of
procedures on 0 to 24 year olds were performed on private patients the proportion
is about 45% for over 65 year olds (Table I7). This compared with around 57% of
the procedures being undertaken on 25 to 64 year olds as private patients;
On average more patients aged 45 to 54 years underwent gynaecological
procedures as private patients than other age groups (Table I7);
Obstetrics age trends were more consistent than gynaecological trends. The age
range of patients was relatively narrow and there was less variation between
individual procedures. Obstetrics procedures were more commonly performed on 25
to 34 year olds than other age groups (62.4% were undertaken on females of this
age bracket, Table I6);
Obstetrics procedures undertaken on private patients tended to be performed on a
slightly older age group (Tables I3 and I4). Obstetrical procedures on public patients
were more likely to be undertaken on 25 to 34 year old age group and next most
likely the younger 15 to 24 years (56.5% and 32.7% of procedures on public
patients, respectively). The peak age for procedures on private patients was also 25
to 34 years followed by the older 35 to 44 group (73.4% and 19.3% of procedures on
private patients, respectively); and
35 to 44 year olds were on the whole more likely to undergo the procedures as
private patients than other age groups (Table I8).
Services Attracting Medicare Benefits
Over the ten year period, 1986-87 to 1996-97, all obstetrics and gynaecology Medicare
services provided by specialists increased by 27.2%. This represents a growth of 2.7%
per annum.
For gynaecological items there was an increase of 8.0% in the period 1986-87 and
1996-97 (0.8% growth per annum).
During the period 1995-96 and 1996-97, Medicare services provided by obstetrics and
gynaecology specialists for obstetric items increased by 42.7% (growth of 21.3% per
annum over the two year period). Only the period 1995-96 to 1996-97 was examined
because in 1995-96 ante-natal visits were included in the number of services for the first
time. Confinement services provided by specialists in obstetrics and gynaecology
decreased by 33.0% in the period 1986-87 to 1996-97.
34
AMWAC 1998.6
Table 10: Obstetrics and gynaecology services attracting Medicare benefits provided by
specialists, 1986-87 to 1996-97
Derived specialty/item
1986-87
1991-92
1992-93
1993-94
1994-95
1995-96
1996-97
Change
1986-87
1996-97
All obstetrics and gynaecology specialists

Confinement items
Providers
775
778
767
720
709
690
681
-12.1%
Confinement items
Services
105,334
97,004
91,287
82,400
79,091
73,524
70,537
-33.0%
787
762
753
706
700
706
725
-7.9%
253,189
174,602
174,507
178,278
173,653
620,074
885,259
834
893
894
934
849
845
853
2.3%
293,433
368,837
360,012
324,714
375,216
344,549
316,849
8.0%
IVF Providers
116
128
80
82
96
102
-12.1%
IVF Services
89,414
90,187
10,673
12,099
12,803
14,326
-83.9
837
899
902
838
862
859
870
3.9%
2,142.6
2,269.5
2,244.7
1,993.9
2,137.9
2,505.8
2,725.2
27.2%
Obstetrics Providers
Obstetrics Services
Gynaecology Providers
Gynaecology Services
Total Providers
Total Services (>000)
42.7%
Notes: a - from 1995-96 ante-natal visits were included in the number of services therefore percentage
change has been calculated for the period 1995-96 to 1996-97; b - percentage difference calculated from
1991-92 to 1996-97
Source: AIHW 1998
The RACOG is the governing body overseeing the obstetrics and gynaecology
profession in Australia and was established in 1978.
The RACOG administers the training program for new specialists and a programme of
continuing education and continuing certification for the Fellows of the College. The
training program is currently six years duration with an introductory four year Integrated
Program and a two year Elective Program. Specialists are initially conferred the status
of Members of the RACOG and subsequently become Fellows with full practising rights.
Fellowships are granted on a time limited basis and Fellows are required to document
their participation in continuing education and quality assurance activities to retain their
Fellowship status (see Appendix E). RACOG also offers certificates in five subspecialties: gynaecological oncology, maternal fetal medicine, uro-gynaecology and
reproductive endocrinology and infertility. The training for which is of three years
duration. The certificate in the sub-specialty of obstetrical and gynaecological ultrasound
requires two years of training.
In March 1998, there were a total of 208 integrated training positions in obstetrics and
gynaecology medicine as shown in Table 11.
35
AMWAC 1998.6
Table 11: Accredited obstetrics and gynaecology training positions, by hospital and State/Territory, 1998
State/Territory
New South Wales (61)
ACT (6)
Victoria (53)
Queensland (40)
South Australia (26)
Western Australia (14)

Tasmania (5)
Northern Territory (3)
Hospital
John Hunter
King George V
Liverpool
Nepean
Royal Hospital for Women
Royal North Shore
St George
Westmead
Canberra
Ballarat Base
Geelong
Mercy Hospitals Inc.
Mildura Base
Monash Medical Centre
Peter MacCallum Cancer Institute
Northern Hospital
Royal Womens
Sunshine
West Gippsland
Warnambool
Western General
Bundaberg Base
Caboolture
Cairns Base
Gold Coast
Ipswich
Kirwan Hospital for Women
Logan
Mackay Base
Mater Mothers
Nambour General
Princess Alexandra
Queen Elizabeth II
Redcliffe
Rockhampton Base
Royal Womens
Toowoomba Base
Flinders Medical Centre
The Lyell McEwin
Modbury
Mt Gambier
Queen Elizabeth
Royal Adelaide
Womens and Childrens
King Edward Memorial
Launceston
Northwest Regional
Queen Victoria
Royal Hobart
Royal Darwin
Total trainees in an ITP (Integrated Training Program)
Accredited positions
6
10
12
3
11
7
5
7
6
1
1
7
1
14
1
1
23
1
1
1
1
1
1
1
2
2
2
4
1
9
2
1
2
3
1
7
1
5
5
2
1
4
3
6
14
1
1
1
2
3
208
Source: RACOG 1998
36
AMWAC 1998.6
In March 1998 there were 282 advanced trainees in obstetrics and gynaecology, the
bulk of whom are in years 1, 2 and 3 of the program (60.1%); reflecting the large
increase in annual intake from 1995 onwards (Table 12). Table 13 shows that 22.3% of
trainees are part time, with female trainees representing 53.9% of part time trainees.
In terms of the State/Territory distribution of trainees, the number in Queensland and
Western Australia is noticeably below those States population shares, and conversely
South Australia has a noticeably higher proportion of trainees compared to population.
The bulk of the trainees are located in New South Wales and Victoria (57.2%/152).
These two States share of trainees is roughly in proportion to their respective population
shares (Table 14). Female trainees are well represented in each State/Territory with the
highest proportions in Queensland (63.8%), the Australian Capital Territory (60.0%) and
New South Wales (58.0%).
Table 12: RACOG trainees, by year of training, age group and gender, 1998
21-25 yrs
26-30 yrs
31-35 yrs
36-40 yrs
41-45 yrs
>45 yrs
Unknown
Total
Male
Year 1
11
25
Year 2
18
Year 3
15
27
Year 4
12
23
Year 5
15
19
Year 6
11
Unknown
Total
27
52
29
126
Female
Year 1
15
10
32
Year 2
18
30
Year 3
13
30
Year 4
13
22
Year 5
20
31
Year 6
10
Unknown
Total
52
62
28
156
Total
Year 1
26
12
57
Year 2
25
58
Year 3
19
24
57
Year 4
25
10
45
Year 5
35
50
Year 6
11
21
Unknown
Total
79
114
57
16
282
65.8
54.4
49.1
43.8
37.5
42.9
55.3
%Female
100.0
Source: RACOG March 1998
37
AMWAC 1998.6
Table 13: RACOG trainees, by full time and part time status, age group and gender, 1998
Gender
21-25 yrs 26-30 yrs
31-35 yrs 36-40 yrs 41-45 yrs
>45 yrs Unknown
Total
Full time
Male
19
39
23
97
Female
45
46
20
122
Total
64
85
43
14
219
100.0
70.3
54.1
46.5
42.9
33.3
33.3
55.7
% female
Part time
Male
13
29
Female
16
34
Total
15
29
14
63
0.0
46.7
55.2
57.1
50.0
50.0
100.0
54.0
% female
Total
Male
27
52
29
126
Female
52
62
28
156
Total
79
114
57
16
282
19.0
25.4
24.6
12.5
25.0
14.3
22.3
% part time
0.0
Table 14: Obstetrics and gynaecology trainees, by State/Territory and gender, 1998
Gender
NSW
Vic
Qld
SA
WA
Tas
ACT
NT
Not
known
Aust
Male
37
29
17
15
12
126
Female
51
35
30
16
11
156
Total
88
64
47
31
20
18
282
% trainees
33.3
24.2
17.8
11.7
7.5
2.0
2.0
1.5
100.0
% popn.
33.9
24.8
18.3
8.1
9.7
2.4
1.7
1.0
100.0
% female
58.0
54.7
63.8
51.6
55.0
40.0
60.0
50.0
33.3
55.3
Source: RACOG March 1998 and ABS
The AIHW medical labour force survey figures for 1995 indicate that specialists in
training in obstetrics and gynaecology worked, on average, a total of 60.8 hours per
week, 61.2 for males and 60.7 hours for females (Tables 15 and 16).
38
AMWAC 1998.6
Table 15: Obstetrics and gynaecology specialists-in-training average hours worked, by gender and
age, 1995
Gender
<35 years
35-44 years
45-54 years
Total
Total hours worked

Male
61.3
60.0
60.0
61.2
Female
59.6
61.5
70.5
60.7
Total
60.4
60.6
67.0
60.8

Male
52.4
57.2
60.0
54.7
Female
56.9
54.2
60.5
57.0
Total
54.8
55.9
60.3
55.7

Male
26.4
32.6
0.0
30.7
Female
39.5
47.5
48.0
40.4
Total
32.1
37.6
48.0
34.8
Source: AIHW
Table 16: Obstetrics and gynaecology specialists in training average hours worked, by
Hours
NSW/ACT
Vic
Qld
WA
SA/NT
Tas
Total
Total worked
67.6
69.0
52.8
52.5
61.0
65.0
60.8
Direct patient care
60.0
55.1
49.5
49.2
53.3
60.0
55.7
On all not worked
43.7
19.1
26.5
39.2
33.4
57.0
34.8
Source: AIHW
Table 17 shows there has been a 34.3% increase in the number of trainees during the
period 1992 to 1998. Trainee numbers increased dramatically in 1995, with a 35.6%
increase on the previous year. Female trainees increased by 85.7% during the period
1993 to 1998.
39
AMWAC 1998.6
Table 17: Obstetrics and gynaecology trainees, by gender, 1992 to 1998

Year
Male
Female
Total
% Female
1992
na
na
185
1993
126
84
210
40.0
1994
103
105
208
50.5
1995
139
143
282
50.7
1996
143
150
293
51.2
1997
126
150
276
54.3
1998
126
156
282
55.3
na - not available
*This includes all registered trainees in RACOG approved training sites in Australia and overseas training
posts; special training sites (eg. Masters Degree at Townsville University, laparoscopic surgery post,
research), which are not an accredited training post; and RACOG sub-specialty training posts in Australia,
as well as prospectively approved posts overseas.
Summary of Main Characteristics of the Specialist Obstetrics and Gynaecology

Workforce
Obstetrics and gynaecology is one of the larger single specialist workforces,
representing 6.4% of all specialists (only anaesthesia and psychiatry have significantly
larger workforces). The Working Party estimates there are currently 1,049 practising
obstetrics and gynaecology specialists in Australia. This represents 14.4 specialists per
100,000 female population (aged 15 years and over) and an estimated SPR of 1:6,954
(female population aged 15 years and over).
Specialist obstetricians and gynaecologists practise mainly in capital cities and
metropolitan areas (84.7% of the workforce). 15.3% of specialists are located in rural
areas (28.5% of the female population). The workforce is unevenly spread between
States/Territories, with Tasmania, Western Australia, Queensland and the Northern
Territory all having an SPR below the national average.
The average age of the workforce is 51.1 years. The largest five year age groups are
the 51 to 55 years (19.4%) and the 46 to 50 years (17.5%). In total, 32.0% (336) of the
workforce are aged 55 years and over; but of this number only 7.0% (74) are aged 65
years and over. Most of the specialists aged 55 years and over are located in New
South Wales and Victoria (197/58.6%).
Women make up 15.1% (158) of the workforce, with this proportion expected to
increase given that 55.3% of current trainees are female and only 21 women are aged
55 years and over. The five year age group with the largest number of women
specialists is the 41 to 45 years (47/29.6% of female specialists).
The Working Party estimated that obstetric and gynaecology specialists work on
40
AMWAC 1998.6
average 62 hours per week. The large majority of the workforce (63.7%) work in private
practice and undertake some public hospital work. Most specialists practice both
obstetrics and gynaecology, and even some of the 98 subspecialists continue to
practice general obstetrics and gynaecology.
41
AMWAC 1998.6
ADEQUACY OF THE CURRENT OBSTETRICS AND GYNAECOLOGY WORKFORCE

There are a number of indicators of the adequacy of a medical workforce. No single
measure can provide a definitive assessment, however by examining each it is possible
to gain an indication of whether a workforce is adequately meeting current demand or if
there is a significant shortfall or oversupply. The indicators chosen by the Working Party
were:
specialist (including sub-specialist):population ratio;
public hospital vacancies;
consultation waiting times;
views of the Divisions of General Practice; and
views of Fellows of RACOG.
Obstetrics and Gynaecology Surgeons:Population Ratio
When considering SPR the Working Party determined that three female population age
groups were important. First, the best general indicator is the population aged 15 years
and over (and this indicator was used in calculating the SPRs shown in Table 1).
Second, obstetric services were really provided to the population aged 15 to 49 years.
Comparisons using the female population aged 25 years and over are also provided.
RACOG has indicated that an acceptable SPR for females in urban areas is 1:10,000
and for rural areas 1:15,000 (see Appendix F: Service Provision and Requirements of
Obstetrics and Gynaecology). The national ratio would therefore be skewed towards the
urban areas as the majority of the female population (64%) is situated in capital
cities/metropolitan areas and could be considered to be approximately 1:12,500.
Table 18 summarises the SPR by State and Territory for each of the three female
population groups.
The SPR for females aged 15 to 49 years is estimated at 1:4,439 or 22.5
specialists/sub-specialists per 100,000 female population or 2.8 per 12,500 female
population. State provision ranged from 15.2 per 100,000 population in the Northern
Territory and 25.2 per 100,000 population in South Australia. Using the national SPR
indicator from RACOG 1:12,500 all States/Territories are well endowed with specialists.
The SPR for females aged over 15 years is estimated at 1:6,954 or 14.4 specialists/subspecialists per 100,000 female population or 1.8 per 12,500 female population. Using
the national SPR indicator from RACOG 1:12,500, all States/Territories are well
endowed with specialists.
The SPR for females aged over 25 years is estimated at 1:5,629 or 17.8 specialists/subspecialists per 100,000 female population or 2.2 per 12,500 female population. Using
the national SPR indicator from RACOG 1:12,500, all States/Territories are well
endowed with specialists.
42
AMWAC 1998.6
Table 18: Specialists/sub-specialists in obstetrics and gynaecology to female population ratio, by

State/Territory, 1998 (number per 100,000 population)
Specialists
NSW
Vic
Qld
SA
WA
Tas
ACT
NT
Total
361
284
170
92
92
24
18
1,049
Females aged 15 years and greater

Population
(>000)
2,483.2
1,845.4
1,308.0
599.4
686.7
188.4
121.9
62.6
7,295.7
6,879
6,498
7,694
6,515
7,465
7,852
6,777
7,820
6,954
No./100,000
14.5
15.4
13.0
15.3
13.4
12.7
14.8
12.8
14.4
No. /12,500
1.8
1.9
1.6
1.9
1.7
1.6
1.8
1.6
1.8
SPR:1

Population
(>000)
2,010.4
1,458.6
1,099.4
486.6
515.0
150.6
92.9
55.6
5,905.2
5,569
5,136
6,467
5,289
5,598
6,275
5,161
6,950
5,629
No./100,000
18.0
19.5
15.5
18.9
17.9
15.9
19.4
14.4
17.8
No. /12,500
2.2
2.4
1.9
2.4
2.2
2.0
2.4
1.8
2.2
SPR:1
Females aged 15 to 49 years

Population
(>000)
1,552.1
1,159.7
865.3
364.9
456.4
117.7
87.5
52.8
4,656.5
4,299
4,083
5,090
3,966
4,961
4,904
4,861
6,600
4,439
No./100,000
23.2
24.5
19.6
25.2
20.2
20.3
20.6
15.2
22.5
No./12,500
2.9
3.1
2.5
3.2
2.5
2.5
2.6
1.9
2.8
SPR:1
Source: RACOG 1998 and ABS 1996 Census: Population by Sex and Age
Table 19 examines the SPR by State and Territory and RRMA classification for the
three female population age ranges.
The capital city/metropolitan SPR for females aged between 15 and 49 years is
estimated at 1:3,817 or 26.2 specialists per 100,000 female population or 2.6 per 10,000
female population. Using the urban SPR indicator from RACOG 1:10,000, only the
Northern Territory falls below this ratio.
The capital city/metropolitan SPR for females aged 15 years and over is estimated at
1:5,796 or 17.3 specialists per 100,000 female population or 1.7 per 10,000 female
population. Using the urban SPR indicator from RACOG of 1:10,000, only the Northern
Territory falls below this ratio.
43
AMWAC 1998.6
The rural/remote SPR for females aged between 15 and 49 years is estimated at
1:7,894 or 12.7 specialists per 100,000 female population or 1.9 per 15,000 female
population. Using the rural SPR indicator from RACOG of 1:15,000 all States/Territories
are well endowed with specialists. There are no rural/remote centres in ACT.
The rural/remote SPR for females aged 15 years and over is estimated at 1:12,614 or
7.9 specialists per 100,000 female population or 1.2 per 15,000 female population.
Using the rural SPR indicator from RACOG of 1:15,000 South Australia and Western
Australia fall below this SPR indicator. For the female population aged 25 years and
over, Western Australia falls below this rural SPR benchmark.
In areas where there are outreach services provided to large remote areas such as
Cairns, RACOG has recommended that there should ideally be at least four specialists
which will allow appropriate cover for those specialists who are on call and/or are visiting
remote areas.
The distribution of specialists in rural/remote areas indicates that generally South
Australia, Western Australia, Queensland and Tasmania fall below the rural RACOG
SPR benchmark for the female population. As indicated earlier RACOG has
recommended that there should ideally be at least two to four specialists (depending on
the size of the catchment population) resident in any one location which will allow
appropriate cover for those specialists who are in large remote areas. The above
analysis of rural/remote SPR levels indicates that these States/Territories may not have
appropriate cover.
The Working Party considered that where population size is below the necessary critical
mass to support a resident specialist, or there are no specialists interested in
establishing a practice in a community large enough to support a resident obstetrics and
gynaecology service, a regular visiting outreach service may become an appropriate
form of service delivery.
44
AMWAC 1998.6
Table 19: Specialists/sub-specialists in obstetrics and gynaecology to female population ratio, by

State/Territory and geographic location, 1998
NSW
Vic
Qld
SA
WA
Tas
ACT
NT
Total
16
18
889
Capital cities and metropolitan areas

Workforce
312
242
130
84
84

Population
(>000)
1,195.7
896.8
522.6
275.3
340.7
50.1
24.7
87.5
3,393.4
3,832.
3,706
4,020
3,278
4,056
3,132
1,370
29,164
3,817
No./100,000
26.1
27.0
24.9
30.5
24.7
31.9
73.0
3.4
26.2
No./10,000
2.6
2.7
2.5
3.1
2.5
3.2
7.3
0.3
2.6
SPR:1

Population
(>000)
1,837.2
1,350.3
795.8
437.5
504.7
77.0
32.0
118.3
5,152.9
5,889
5,580
6,122
5,208
6,008
4,814
1,780
39,450
5,796
No./100,000
17.0
17.9
16.3
19.2
16.6
20.8
56.2
2.5
17.3
No./10,000
1.7
1.8
1.6
1.9
1.7
2.1
5.6
0.3
1.7
160
SPR:1
Rural and remote areas

Workforce
49
42
40

Population
(>000)
356.4
262.9
342.7
89.6
115.6
67.6
28.1
85
1,263.1
SPR:1
7,273
6,259
8,568
11,206
14,456
8,449
5,624
7,894
No./100,000
13.7
16.0
11.7
8.9
6.9
11.8
17.8
12.7
No./15,000
2.1
2.4
1.8
1.3
1.0
1.8
0.0
2.7
1.9

Population
(>000)
591.1
421.4
545.7
145.0
171.2
105.3
38.2
112
2,018.2
12,064
10,034
13,644
18,126
21,401
13,163
7,644
12,614
No./100,000
8.3
10.0
7.3
5.5
4.7
7.6
13.1
7.9
No./15,000
1.2
1.5
1.1
0.8
0.7
1.1
0.0
2.0
1.2
SPR:1

Population
(>000)
499.2
353.9
455.9
124.4
142.9
87.6
87
30.0
1,694.1
10,187
8,427
11,399
15,546
17,860
10,951
6,019
10,587
No./100,000
9.8
11.9
8.8
6.4
5.6
9.1
16.6
9.4
No./15,000
1.5
1.8
1.3
1.0
0.8
1.4
0.0
2.5
1.4
SPR:1
Source: RACOG 1998, ABS 1996 Census: Population-Capital city/Metropolitan & Rural/Remote
45
AMWAC 1998.6

The 1997 AMWAC survey of public hospital specialist vacancies found there were 17
obstetrics and gynaecology vacancies (13.5 full time equivalents). There were 6 (4.2
FTEs) vacancies in New South Wales, one (1 FTE) in Victoria, 8 (6.3 FTEs) in
Queensland, one (1 FTE) in South Australia and one (1 FTE) in Tasmania. There were
no vacancies in Western Australia. In addition, nine vacancies were filled by TRDs;
seven TRDs in New South Wales and one TRD in both Queensland and Western
Australia.
Provider Shortages
Respondents to the RACOG/AMWAC survey were asked to specify any providers in
short supply in their primary practice location. Table B15, Appendix B indicates that
according to respondents there is a need for more obstetricians and gynaecologists,
midwives, anaesthetists, paediatricians and psychiatrists. The survey data revealed a
strong association between perceived need for more obstetricians and gynaecologists
and geographic location. In total, 80.2% (219) metropolitan and 17.2% (47) of rural
specialists indicated a need for more obstetricians and gynaecologists compared with
respondents (n=273). In rural and remote areas respondents indicated a greater need
for more midwives, obstetric GPs, anaesthetists, paediatricians, psychologists and
psychiatrists than obstetricians and gynaecologists.
For dedicated obstetrics and gynaecology units, respondents to the 1997
RACOG/AMWAC survey were asked to estimate the average waiting time for a
standard first consultation and an urgent condition.
Table 20 shows that the average waiting time for a standard first consultation with a
specialist in obstetrics and gynaecology in his/her private rooms was 16.9 days
(standard deviation 18.0) while for public patients the wait, on average, was 31.9 days
(standard deviation 48.4). The waiting time in Tasmania for public patients was
noticeably above the national average.
For an urgent condition, private patients were shown to wait much less time (2.0 days,
standard deviation 4.1) than did patients in public outpatient departments (7.1 days,
standard deviation 18.5) (p<0.01); with public patients in Queensland and the Northern
Territory waiting above average times.
46
AMWAC 1998.6
Table 20: Obstetrics and gynaecology average waiting time (days) for a standard first consultation
and an urgent procedure, by private rooms/public outpatients department and State/Territory, 1997
(n=501)
State/Territory
Standard consultation
Urgent condition
Private patients
NSW
16.0
2.4
Victoria
19.1
1.9
Queensland
17.2
2.3
Western Australia
15.4
1.7
South Australia
12.7
1.1
Tasmania
15.9
1.0
Northern Territory
10.5
2.5
ACT
40.8
2.7
Total
16.9
2.0
NSW
21.9
4.5
Victoria
23.4
5.4
Queensland
37.6
14.0
Western Australia
47.8
7.7
South Australia
32.1
5.7
141.5
5.8
Northern Territory
38.5
14.0
ACT
16.3
5.3
Total
31.9
7.1
Public patients
Tasmania
Source: RACOG/AMWAC Survey

To gain a GP perspective on the adequacy of the specialist workforce, AMWAC
surveyed the Divisions of General Practice, and the results of the survey are detailed in
Appendix G. The survey found that 55.4% of Divisions considered that a shortage of
obstetrics and gynaecology specialists existed in their area, with the remaining
proportion predominantly of the view that supply was about right. A greater proportion of
rural divisions (61.5%) perceived the supply of specialists to be inadequate than did
Divisions located in urban areas (50.0%).
47
AMWAC 1998.6
Overall, 69.9% (n=485) of respondents (both specialists and sub-specialists) to the
RACOG/AMWAC survey were satisfied with their work. Aspects of their work with which
they were most satisfied were sufficient work to maintain competence, physical working
conditions, opportunity to use your abilities and the availability of other specialists.
Aspects of their work with which they were most dissatisfied (in order of percentage of
people expressing dissatisfaction) were industrial relations between management and
workers in their health service (26.5%), workload sufficient to maintain income (25.5%),
hours of work (22.6%), and amount of work (22.4%) (Table B18, Appendix B).
Medical Indemnity Insurance
One of the issues confronting the obstetrics and gynaecology profession is the real and
potential withdrawal of specialists from obstetrics, in part induced by the fear of being
sued and high indemnity insurance premiums. Any trend has to be seen against the
backdrop of the traditional career changes of obstetrics and gynaecology specialist
away from obstetrics as they get older, and the effect on recruitment of trainees to the
profession. Respondents to the RACOG/AMWAC survey indicated that rising medical
indemnity insurance premiums will affect the way they practice with 83% (403) indicating
that they would either cease practising obstetrics or retire early and 9% indicating that
they would pass cost on to patients.
Conclusions on the Adequacy of the Current Obstetrics and Gynaecology
Workforce
Overall, the Working Party concluded that there is some indication of a slight workforce
shortage, particularly when public hospital vacancies and consultation waiting times are
considered. Waiting times for a standard public patient were found to be noticeably
higher for patients in Queensland, Western Australia, Tasmania, South Australia and
Northern Territory. However, these regional shortages may relate more to
maldistribution of the workforce than any significant shortage in the workforce as a
whole, especially as the SPR data indicated that most States/Territories had an SPR
above the suggested benchmark. The SPR data also showed that in capital
cities/metropolitan areas all States/Territories are currently well supplied with obstetrics
and gynaecology specialists, with the exception of the Northern Territory. In rural/remote
areas South Australia and Western Australia remain below the national rural/remote
SPR.
However, despite the conclusion of possible shortages, no short term remedial action is
recommended by the Working Party, mainly because RACOG dramatically boosted
trainee numbers in 1995 and when these trainees commence making a contribution to
the workforce from 2001 onwards it is anticipated that shortages in the workforce should
begin to diminish.
48
AMWAC 1998.6
PROJECTIONS OF REQUIREMENTS
Female Population
In 1997 Australia's female population was estimated to be 9.31 million compared to 8.72
million in 1991. The ABS estimates that the female population will reach 9.631 million by
2001 and 10.11 million by 2006 (ABS 1997) (Table 21). Between now and 2006 there is
a projected growth of 0.9% growth per annum in the female population. Between now
and 2011 the projected growth per annum of females will be 0.93%. The projected
growth of the female population is expected to fall to 0.85% per annum by 2036 and to
0.81% per annum by the year 2041. This slow down in growth is being caused by the
ageing of the population and a decline in the fertility rate.
Table 21: Australian female population estimates and projections, 1997 to 2006
Females
1993
1995
1997
2001
2006
> 15 years
6,998,724
7,108,294
7,403,647
7,697,000
8,142,200
>25 years
5,657,321
5,858,964
6,097,953
6,412,600
6,813,500
15 to 49 years
4,660,453
4,734,965
4,820,066
4,843,900
4,932,100
> 49 years
2,338,271
2,445,329
2,583,581
2,853,100
3,210,100
Total female population
8,866,241
9,073,430
9,314,231
9,631,900
10,105,300
Source: ABS, Australian Demographic Statistics, 3101.0, June quarter 1997 and ABS, Projections of the
Populations of Australia, States and Territories, 1995 - 2051, Series A/B
The projected growth rate of the female population differs across age cohorts. For
example the population growth of younger women should be fairly small over the next
20 years (numbers of women under 45 years of age are expected to increase by only
3.4%) whilst growth in numbers of women aged 45 or over should be relatively high
(50.3%).
Increasing proportions of elderly people and decreasing proportions of births due to a
fall in fertility rates will also result in the median age of the total population rising from
34.1 years currently to between an estimated 39.4 and 41.8 years in 2041 (ABS 1994).
Overall, the ageing of the female population, combined with the heavy utilisation of
medical services by this group, can be expected to lead to an increase in the demand
for services by the older female population.
49
AMWAC 1998.6
Fertility Rate
The total fertility rate is the number of births that a woman could expect to have, based
on current age-specific birth rates. Australias total fertility rate has been falling over the
last two decades, from 2.9 babies per woman in 1971 to 1.8 in 1996. Since the mid
1970s, the total fertility rate has remained below the natural replacement level of 2.1
babies per woman.
The decline in the fertility rate has been accompanied by changes in the age pattern of
fertility, with the median age of confinement increasing to 28.7 years. Associated with
this trend has been an increase in the proportions of births occurring to older women
and a decline in the number of women having three or more births. The age group for
peak fertility in 1996 was 25 to 29 years old, followed by 30 to 34 years old (ABS 1997).
Most of the decline in the fertility rate over the period 1976 to 1996 occurred among
younger women. The fertility of women aged less than 24 years declined by 48%, while
that for women aged 25 to 29 years declined by about 20%. On the other hand, the
fertility of women aged 30 to 34 years and 35 to 39 years increased during the period
(ABS 1997).
The total fertility rate in 1996 varied substantially between the States and Territories,
from 1.7 births per woman in Victoria to 2.3 in the Northern Territory. Between 1976 and
1996, the total fertility rate declined in all States and Territories. However, between 1986
and 1996, the rate for the Northern Territory increased slightly, while the rate for South
Australia and Tasmania remained largely unchanged (Table 22)
Table 22: Total fertility rate, by State/Territory, 1976, 1986 and 1996
NSW
Vic
Qld
SA
WA
Tas
NT
ACT
Aust
1976
2.04
2.03
2.18
1.86
2.14
2.09
3.06
2.09
2.06
1986
1.91
1.78
1.91
1.76
1.98
1.93
2.21
1.74
1.87
1996
1.83
1.71
1.84
1.75
1.81
1.92
2.29
1.68
1.80
Source: ABS, Births, September 1997, 3301.0
For all States and Territories, expect the Northern Territory, the largest contribution to
the total fertility rate in 1996 was made by women aged 25 to 29 years followed by
women 30 to 34 years. In the Northern Territory, the age group of peak fertility was 20
to 24 years, followed by 25 to 29 years. The Northern Territory has a much younger
fertility age structure, with women aged less than 25 years comprising 43% of the total
fertility rate, compared to contributions of between 18% and 30% for the other States.
The age-specific birthrate for 15 to 19 year old women was more than three to four
50
AMWAC 1998.6
times as high in the Northern Territory as it was in other States and the Australian
Capital Territory, while the age-specific birth rate for women aged 20 to 24 years in the
Northern Territory was one to two times higher than rates for other States and the
Australian Capital Territory.
Indigenous women have an above average fertility when compared with women in the
total Australian female population. For example, in 1996, the total fertility rate of
Indigenous women ranged between 2.1 in South Australia to 2.7 in the Northern
Territory. Indigenous women having a baby in 1996 were, on average, younger than
women in the total Australian population. The median age at confinement among
Indigenous women was between 23 and 24 years compared to 29 years among all
Australian women.
Birth Rate
The 253,834 births registered in 1996 represented an 11.3% increase over the number
registered in 1976 (228,000) and a 4.3% increase over the number registered in 1986
(243,408). However, despite an increase in the total number of births, the actual birth
rate declined between 1976 and 1996.
Crude birth rate refers to the number of live registered births during a calender year per
1,000 population. Table 23 shows the Australian birth rate falling from 15.2 births per
1,000 population in 1986 to 13.9 births per 1,000 population in 1996. In addition, the
average age of women giving birth to their first child in Australia has increased
substantially over the last twenty years, from 25.9 years in 1976 to 29.2 years in 1996
(ABS Births 1997).
Table 23: Total births, by State/ Territory, 1996
Birth rates
1986
1991
1992
1993
1994
1995
1996
Total births
243,408
257,247
264,151
260,229
258,051
256,190
253,834
Crude birth rate
15.2
14.9
15.1
14.7
14.5
14.2
13.9
Total fertility rate
1.870
1.855
1.894
1.865
1.846
1.824
1.796
Female net
reproduction rate
0.895
0.890
0.909
0.896
0.886
0.876
0.860
Source: ABS, Births, September 1997, 3301.0
New South Wales, Victoria and Queensland accounted for nearly three-quarters of
births registered in 1996. Out of the total 254,834 births registered in 1996, 34.1% were
registered in New South Wales, 24.1% were registered in Victoria and 18.8% were
registered in Queensland (Table 24). These proportions broadly reflect the distribution of
51
AMWAC 1998.6
the female population in the reproductive ages.

Table 24: Total births, by State/ Territory, 1996
NSW
Vic
Qld
SA
WA
Tas
NT
ACT
Aust
86,595
61,143
47,769
19,056
24,793
6,457
3,562
4,396
253,834*
34.1
24.1
18.8
7.5
9.8
2.6
1.4
1.7
100.0
557
1,538
1,343
66
3,504
Crude birth rate
14.0
1.5
14.2
12.9
14.1
13.6
20.0
14.3
13.9
Total fertility rate
1.825
1.712
1.840
1.746
1.812
1.916
2.286
1.677
1.796
Births
% births
Indigenous births
* includes 63 births recorded in other Territories

Source: Births, ABS September 1997, 3301.0
At the national level, while the overall number of births registered grew by 11% between
1976 and 1996, among States and Territories the rate of growth varied. The number of
births registered grew faster in Queensland (35.4%), the Northern Territory (32.5%) and
Western Australia (19.8%) than in New South Wales (10.6%), the Australian Capital
Territory (2.0%), Victoria (1.2%) and South Australia (1.0%). In Tasmania the number of
births declined by 4.1%.
In 1996, the crude birth rate was 20.0 per 1,000 population for the Northern Territory
and between 12.9 and 14.3 for the remaining States and the Australian Capital Territory.
South Australia had the lowest crude birth rate (12.9) followed by Victoria (13.5) and
Tasmania (13.6). The high crude birth rate in the Northern Territory is attributable to its
young age structure and the large proportion of Indigenous people; a population
characterised by a comparatively high fertility rate and low life expectancy (ABS/AIHW
1997).
There has been a trend towards greater numbers of mothers planning to give birth in a
birth centre from 2,405 in 1992 to 4,199 in 1995 (Perinatal Statistics, Australia=s
Mothers and Babies 1995). This may also be explained by the availability of birth
centres. There has also been a trend towards the implementation and increased
utilisation of midwifery focused models of care in antenatal clinics and an expansion of
domiciliary midwifery programs, with a move to integrate these services with community
based care.
Cancer of the Cervix, Ovary and Uterus
Cervical cancer is the seventh most common cancer in women. However, the incidence
of cervical cancer is declining in Australia, with an average annual rate of decline of
1.3% between 1983 and 1994. The incidence on the whole is expected to decrease
52
AMWAC 1998.6
from 13.73 women per 100,000 population in 1989 to a projected 10.41 women per
100,000 population in 1999, a decrease of 1.5% per annum. However, an agedependent variation has been noted in trends. Among women aged 50 years and over,
the incidence of cancer of the cervix has fallen since 1983, while rates for those under
the age of 50 years have increased slightly.
The incidence of cervical cancer varies substantially at the State and Territory level. Of
the States, Queensland (18.2) and Western Australia (20.9) showed the highest rates,
whereas South Australia (15.9) showed the lowest rate among women aged 20 to 74
years for the period 1988-90.
Table 25: Incidence of cancer of the cervix among women aged 20 to 74 years, by State/Territory
State/Territory
Average 1983-85
Average 1988-90
% change
NSW
17.5
16.6
-4.7
Victoria
16.8
16.5
-1.8
Queensland
22.7
18.2
-20.1
West. Aust.
22.3
20.9
-6.4
South Aust.
18.3
15.9
-13.2
Tasmania
20.7
20.0
-3.6
ACT
18.0
18.4
2.0
North. Terr.
31.5
30.3
-3.8
Australia
18.7
17.4
-7.3
Source: AIHW, National Health Priority Areas 1996
The incidence rate of ovarian cancer is marginally declining in Australia with the
incidence rate 11.10 per 100,000 female population in 1989 to a projected 10.93 per
100,000 female population in 1999, a decrease of 0.1% per annum. The incidence rate
of cancer of the uterus is increasing in Australia with the incidence rate at 11.85 per
100,000 female population in 1989 projected to 14.86 per 100,000 female population in
1999, an increase of 0.03% per annum. (Cancer in Australia 1991-1994 (with
Projections to 1999), AIHW 1998).
Table 26 shows projections for the age standardised incidence rates of cancer of the
cervix, ovary and uterus and indicates a fall for both cancer of the cervix and ovarian
cancer but an increase in cancer of the uterus.
53
AMWAC 1998.6
Table 26: Age standardised rates for incidence of cancer of the cervix, ovary and uterus, selected
years 1983 to 1994, with projections to 1999
Cancer
1983
1989
1994
1995
1996
1997
1998
1999
Cervix
13.73
12.37
11.97
11.17
10.98
10.79
10.60
10.41
Ovary
11.10
11.35
10.75
10.90
10.90
10.91
10.92
10.93
Uterus
11.85
11.84
13.38
13.67
13.97
14.26
14.56
14.86
Source: AIHW, Cancer in Australia 1991-1994 (with Projections to 1999), 1997
Trends in Utilisation
Forecasts of future obstetrics and gynaecology procedure usage have been calculated
by applying projections of the female population to the hospital age utilisation data for
1995-96. It should be noted that this is a simple approach which assumes that
population change is the only factor affecting the demand for obstetrics and
gynaecology procedures. The projections ignore, for example, the impacts of new
technology and change in medical practice, which are extremely difficult to assess let
alone quantify.
In general, obstetrics procedures are mainly undertaken on younger females and are
therefore forecast to increase by a relatively small amount, while gynaecology
procedures, which are distributed more widely across the age spectrum, are expected to
increase more rapidly.
The utilisation projections suggest that in general the demand for gynaecology
procedures over the next 20 years will not increase as quickly as the population. Over
this period female population is expected to increase by 19.8%, whereas gynaecology
services, based on current rates, are expected to grow by 14.0% or 0.7% per annum.
The reason for the lesser growth is that the majority of gynaecological procedures are
undertaken on young to middle aged women, and this younger female age group is
growing less rapidly than the population aged 45 years and over (in 1995-96, 72.4% of
procedures were undertaken on women up to age 44 years, Table I5).
Growth in the number of obstetrics procedures over the next 20 years is expected to be
considerably less than population growth. Female population growth of 19.8% is
anticipated, while the demand for obstetrics procedures is only forecast to rise by 2.2%
or 0.1% per annum. This is because proportionally more obstetrics procedures are
performed on women in the younger age groups, which as already indicated, are
growing less rapidly than older age groups (in 1995-96, 86.3% of procedures were
undertaken on women up to age 34 years, Table I6).
54
AMWAC 1998.6
Table 27: Projected increases in utilisation for obstetrical and gynaecological procedures, 1998 to
2018
A. Female population
Age (years)
Year
0-14
1524
2534
3544
4554
5564
6574
75+
Total
1,891,00
4
1,321,347
1,425,973
1,386,449
1,118,065
754,395
679,305
52,346
9,128,884
1998
1,921,33
0
1,298,799
1,455,691
1,444,970
1,223,172
800,255
677,122
604,266
9,425,605
2018
1,992,80
4
1,409,417
1,456,720
1,466,979
1,530,796
1,427,175
1,117,264
892,450
11,293,605
3.7
8.5
0.1
1.5
25.1
78.3
65.0
47.7
19.8
Actual
19959
6
Forecasts:
%
increase
B. Gynaecological procedures
Age (years)
Year
014
1524
2534
3544
4554
5564
6574
75+
Total
1,417
71,379
165,873
149,950
84,783
31,983
21,615
9,922
536,922
1998
1,440
70,161
169,330
156,279
92,753
33,927
21,546
10,855
556,291
2018
1,493
76,137
169,450
158,660
116,080
60,506
35,551
16,031
633,907
3.7
8.5
0.1
1.5
25.1
78.3
65.0
47.7
14.0
Actual:
199596
Forecasts:
% increase
1998-2018
C. Obstetrics procedures
Age (years)
Year
014
1524
2534
3544
4554
5564
6574
75+
Total
193
84,437
221,612
48,556
231
355,037
1998
196
82,996
226,231
50,606
253
360,287
2018
203
90,065
226,391
51,376
316
11
368,366
% increase
1998-2018
3.7
8.5
0.1
1.5
25.1
78.3
0.0
0.0
2.2
Actual:
199596
Forecasts:
Sources: ABS population projections, series A and AIHW National Hospital Morbidity Database.
55
AMWAC 1998.6
It should also be noted that the number of obstetrics and gynaecology confinements in
the private sector has decreased by 40.5% over the last ten years (AIHW, 1995). The
Working Party considers the major driving factor has been the declining levels of people
with private health insurance and a corresponding increase in patient co-payments. In
1986-87 there were approximately 105,334 private sector confinements and in 1996-97
there were 70,537 representing a fall of 33%. It is anticipated that confinements in the
private sector will continue to fall. In turn, this is likely to have an adverse effect on the
participation of obstetricians who are faced with a smaller pool of private patients and an
increasing level of medical indemnity insurance making the practice of obstetrics less
attractive.
Despite this trend, the utilisation projections suggest that the Australian female
population will continue to require obstetric and gynaecology specialist services (Table
27) and that the specialist obstetric and gynaecology workforce will be required to meet
these demands.
The Impact of Changes in Technology
From a technological perspective, there is no current trend which will have any radical
impact on the general configuration of service delivery. However, telehealth is an
emerging technological development which is expected to improve access for rural
patients and doctors to consultations with specialists. Such developments will be
evolutionary and are currently underway in several Australian States. These
developments require evaluation along the way. Conceivably, this might impact on costs
of service delivery and training/education support as well as improve care outcomes.
The future of ultrasonography in obstetric practice may also need to be closely
monitored as it may significantly change current practices.
Specialists Perceptions on Factors Affecting Workforce Requirements
Respondents to the RACOG/AMWAC survey of obstetricians and gynaecologists were
asked to indicate whether they believed particular factors would increase workforce
requirements, decrease workforce requirements or whether requirements would stay the
same (refer to Table B19, Appendix B). Among the important issues that respondents
(both specialists and sub-specialists) considered would increase requirements included:
the practice of more defensive medicine, patients expectations and knowledge,
advances in medical technology, and need for improved geographic distribution of
specialists. Factors perceived as most likely to decrease workforce requirements were
substitution of specialist services by other providers, requirements for procedural
practice, and government cost containment strategies.
56
AMWAC 1998.6
PROJECTIONS OF SUPPLY
Additions and Losses to the Obstetrics and Gynaecology Workforce
The RACOG/AMWAC Survey asked respondents to provide details of their retirement
intentions. The average expected age of retirement from the workforce was 63 years
(range 50 to 80 years; standard deviation 4.6). Table B7 Appendix B, indicates that
22.7% (113) of survey respondents intend retiring in the next five years.
Examining the age and sex distribution of the specialist workforce shows that the
majority (52.7%) of the workforce is aged over 50 years, 32.0% of the workforce is aged
55 years and over and 18.0% are aged over 60 years. Assuming the average retirement
age from the RACOG/AMWAC survey of 63 years, it can be estimated that there could
be approximately 200 (21%) specialists intending to retire in the next five years.
In 1997 there were approximately six losses from the total workforce migrating
overseas; however, this was balanced with an equal number of specialists in obstetrics
and gynaecology entering Australia. It is probably safe to assume that on balance
immigration and emigration will be roughly equal.
RACOG expects trainee graduations over the next seven years to be: 45 in 1998, 21 in
1999, 50 in 2000, 47 in 2001, 57 in 2002, 49 in 2003 and 42 in 2004; that is an average
of 47 graduates per year.
Respondents to the RACOG/AMWAC survey indicated that rising medical insurance
indemnity premiums will affect the way they practice with 83% (403) indicating that they
would either cease practising obstetrics or retire early.
Female Participation in the Workforce
It is expected that the proportion of women in the workforce will increase; given the
continuing increase in the number of female trainees. Women represent 15.5% the
current total workforce, but 55.3% of trainees. In addition, of the 336 specialists aged 55
years and over, only 21 are female.
The expected lifetime hours worked by a female obstetrics and gynaecology specialist
has been estimated at 74.1% of that of a male (AMWAC/AIHW 1996). In conducting the
projection analysis, the expected supply has been adjusted to account for increasing
female participation and for the expected lower lifetime workforce contribution.
57
AMWAC 1998.6
Provision of Services in Rural and Remote Areas

Provision of specialist services outside capital cities and major urban areas will continue
to be of concern, as there appears to be little incentive to practice in rural areas. This
was evident in the findings of the RACOG/AMWAC Survey (Appendix B) and RACOGs
Womens Career Survey (Appendix E). Reasons stated included the long hours,
professional isolation, career dislocation, lack of relative financial reward, the strain on
the family and spouse, lifestyle issues, and the lack of locum cover when on leave.
There are obviously some communities where there is insufficient workload to warrant
recruitment of consultant obstetrics and gynaecology specialists/sub-specialist. In those
locations it will be important to encourage GPs and midwives to obtain, maintain and
utilise their skills in obstetrics and gynaecology to provide some of these services.
The biggest challenge for RACOG and the government is to make visiting posts and
resident rural posts attractive for specialists. Respondents from the RACOG/AMWAC
survey (refer to Appendix B) indicated that the basic requirements for providing a
sustainable rural outreach obstetrics and gynaecology service and/or a resident rural
practice do not exist in many locations or are only partially provided. For example,
respondents noted problems with:
inadequate local hospital facilities/equipment, such as appropriate consulting
facilities and surgical equipment;
limited or absent numbers of allied health professionals and ancillary staff such as
midwives/nursing, physiotherapists and dieticians;
limited or absent number specialist services such as anaesthetists, paediatricians,
psychiatrists, psychologists, neonatologists;
a lack of interest and support of local GPs;
good transport to the area for both patients and specialist; and
the absence of local accommodation for patients to attend clinics particularly in the
case of the Northern Territory for the Indigenous population.
The Working Party recommends that a rural cadetship be established to attract
specialists to rural areas who desire to set up in rural practice. Commonwealth and
State/Territory health departments should oversee the funding and establishment of
rural cadetships to attract final year trainees to rural areas who desire to set up in rural
practice.
Contribution of Services by Non-specialist Providers
One of the features of obstetrics and gynaecology is the scope for non-specialist
providers to provide at least some of the services in obstetrics and minor gynaecological
procedures. There are no definitive data sources that enable the level of substitution to
be assessed, however Medicare data does provide an indication of the number of
services provided by specialists and non specialists
58
AMWAC 1998.6
When private services are alone considered the majority of Medicare obstetrics and
gynaecology services are provided by specialist obstetricians and gynaecologists. Table
28 shows that in 1996-97, 86.5% of confinements provided by obstetricians and
gynaecologists, 57.2% of obstetric items and 75.3% of gynaecological items. Table 28
also shows there has been a fall of 5.6 percentage points in the number of obstetric
services provided by a GP during the period 1995-96 and 1996-97. Similarly, obstetrics
services provided by specialists increased by 5.7 percentage points and confinement
items provided by specialists increased by 1.5 percentage points.
Table 28: Percentage of obstetrics and gynaecology services attracting Medicare benefits, by
provider, selected years 1986-87 to 1996-97
Provider
Confinement
items
Obstetrics
Gynaecology
IVF group
Total
Percentage of services provided by provider, 1996-97

O&G specialists
86.5
57.2
75.3
12.1
59.1
Other specialists
0.1
0.2
1.0
1.7
0.4
13.3
42.6
23.7
86.3
40.6
GPs

O&G specialists
85.0
51.5
75.4
11.2
56.0
Other specialists
0.2
0.3
1.1
2.2
0.7
14.8
48.2
23.5
86.6
43.3
GPs

O&G specialists
84.0
36.9
79.2
92.3
73.1
Other (incl. GPs)
16.0
63.1
20.8
7.7
26.9

O&G specialists
76.9
53.1
72.4
67.5
Other (incl. GPs)
23.1
46.9
27.6
22.5
Source: AIHW 1998
In terms of obstetrics it is clear that there has been a relative decline in the provision of
privately provided services by GPs against the backdrop of a falling number of private
deliveries overall. In 1986, 23.1% of private deliveries were performed by GPs, in 199697, the proportion was down to 13.3%, in other words, a dominant trend has been
declining involvement of GPs in private obstetrics. As a consequence the proportion of
private deliveries undertaken by obstetrics and gynaecology specialists has risen
markedly, to the point that nearly 90% of all private deliveries are undertaken by
specialists.
59
AMWAC 1998.6
Table 29 indicates the numbers of services attracting Medicare benefits provided by

GPs compared to obstetric and gynaecology specialists by State/Territory.
In each of the four groupings shown in Table 29 and overall, Queensland and Western
Australia show GP involvement above the national average. In antenatal care South
Australia and Northern Territory GP involvement is also above the national average, as
is the involvement of GPs in the management of labour in Tasmania and the Northern
Territory.
States/Territories with GP involvement below the national average are New South
Wales, Tasmania and the Australian Capital Territory. These figures indicate that there
is a predominant role taken by GPs in providing obstetrics and gynaecology services in
some of the less populous States/Territories, much of which is likely to be in provincial
and rural/remote areas.
Table 29: Obstetrics and gynaecology Medicare services, by provider and State/Territory, 1995-96
NSW
Vic
Qld
SA
WA
Tas
ACT
NT
Total
Antenatal care: item numbers 16500 to 16514

O&G spec.
210,194
188,971
88,268
45,019
46,589
17,86
1
14,135
4,691
615,728
GP
151,425
161,719
97,523
47,915
86,611
10,63
9
9,583
5,739
571,154
Sub-total
361,619
350,690
185,791
92,934
133,20
0
28,50
0
23,718
10,430
1,186,88
2
% O&G
spec.
58.1
53.9
47.5
48.4
35.0
62.7
59.6
45.0
51.9
% GP
41.9
46.1
52.5
51.6
65.0
37.3
40.4
55.0
48.1
Management of labour and delivery: item numbers 16515 to 16525

O&G spec.
25,565
19,255
13,055
5,808
6,333
1,892
1,360
670
73,938
2,866
2,949
3,227
676
2,093
495
211
180
12,697
28,431
22,024
16,282
6,484
8,426
2,387
1,571
850
86,635
% O&G
spec.
89.9
86.7
80.2
89.6
75.2
79.3
86.6
78.8
85.3
% GP
10.1
13.3
19.8
10.4
24.8
20.7
13.4
21.2
14.7
GP
Sub-total
Interventional techniques: item numbers 16600 to 16636

O&G spec.
1,431
625
281
1,191
437
116
130
98
4,309
Other spec.
916
148
37
31
70
152
1,354
GP
2,616
3,079
1,722
108
983
19
27
8,554
Sub-total
4,963
3,852
2,040
1,330
1,490
135
309
98
14,217
60
AMWAC 1998.6
NSW
Vic
Qld
SA
WA
Tas
ACT
NT
Total
% O&G
spec.
28.8
16.2
13.8
89.5
29.3
85.9
42.1
100.0
30.3
% oth. spec.
18.5
3.8
1.8
2.3
4.7
49.2
9.5
% GP
52.7
79.9
84.4
8.1
66.0
14.1
8.7
60.2
Gynaecological: item numbers 35500 to 35729

O&G spec.
127,714
87,812
52,179
23,026
36,190
8,237
8,455
1,887
345,500
Other spec.
1,467
1,256
603
280
875
97
95
11
4,684
41,893
24,104
19,814
2,655
15,018
898
2,042
101
106,535
171,074
113,172
72,596
25,971
52,083
9,232
10,592
1,999
456,719
74.7
77.6
71.9
88.7
69.5
89.2
79.8
94.4
75.6
0.9
1.1
0.8
1.1
1.7
1.1
0.9
0.6
1.0
24.5
21.3
27.3
10.3
28.8
9.7
19.3
5.1
23.3
GP
Sub-total
% O&G
spec.
% oth. spec.
% GP
All obstetrics and gynaecological : item numbers 13200 to 3579

O&G spec.
367,760
298,980
157,603
75,794
90,832
28,70
2
24,929
7,351
1,051,95
1
Other spec.
3,106
1,533
1,182
923
1,425
418
250
15
8,852
GP
231,365
219,525
143,299
60,650
112,03
2
13,15
7
12,572
6,040
798,640
Sub-total
602,231
520,038
302,084
137,367
204,28
9
42,27
7
37,751
13,406
1,859,44
3
61.1
57.5
52.2
55.2
44.5
67.9
66.0
54.8
56.6
0.5
0.3
0.4
0.7
0.7
1.0
0.7
0.1
0.5
38.4
42.2
47.4
44.2
54.8
31.1
33.3
45.1
43.0
% O&G
spec.
% oth. spec.
% GP
Percentage of obstetrics and gynaecological services provided by GPs: items 16500 to 35729*
% GP total
35.1
39.2
44.2
40.5
53.6
29.9
32.8
45.0
40.1
* Items commonly performed by specialists/sub-specialists in obstetrics and gynaecology

Source: AIHW 1997
Training of General Practitioners

GPs wishing to provide obstetrics and gynaecology services complete an additional
training program in obstetrics and gynaecology overseen by the Joint Consultative
Committee - RACOG and RACGP. Data provided by RACOG shows that currently there
are 2,845 GPs who have completed the training. The majority of these GPs are located
in Victoria (35.1%) and New South Wales (25.0%). The 1996 Centre For Rural Health
61
AMWAC 1998.6
Rural General Practitioner survey had 541 respondents who indicated they practised in
obstetrics and gynaecology and of these respondents the majority (75.1%) were located
in small rural and remote areas. Further data on GPs providing obstetrics and
gynaecology services is provided in Appendix H.
Medicare data indicates that in 1995-96, 60.1% obstetrics service providers (including
GPs) were located in a capital city, 6.7% in another metropolitan area, 9.2% in a large
rural centre, 9.4% in a small rural centre, 11.8% in another rural area, and 2.9% in
remote areas (Table 30). Comparing this data with the distribution of obstetrics and
gynaecology specialists indicates that GPs represent an increasingly higher proportion
of obstetrics providers, as a function of remoteness of the locality from a metropolitan
area.
Table 30: Distribution of obstetrics and gynaecology Medicare service providers, by geographic
location, 1995-96
Patient location
Provider location
Capital
city
Other
metro
Large
rural
centre
Small
rural
centre
Other
rural
centre
Remote
centre
Other
remote
Total
97.8
4.9
1.6
3.9
11.3
5.6
12.4
60.1
Other metropolitan
0.5
92.3
0.4
2.0
2.1
1.0
1.1
6.7
Large rural centre
0.2
0.2
94.7
3.2
11.8
5.6
7.4
9.2
Small rural centre
0.5
0.8
1.4
87.7
7.5
1.0
10.3
9.4
Other rural centre
0.8
1.7
1.6
2.8
66.2
0.8
8.4
11.8
Other rural area
0.1
0.1
0.2
0.1
0.4
82.4
12.4
1.6
Other remote
0.1
0.2
0.2
0.2
0.6
3.6
47.9
1.3
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
Capital city
Total
Source: DHFS
The other key alternative providers are midwives. The AIHW Nursing Labour Force
Survey shows that in 1995 there were 13,913 registered midwives and 1,540 nurses
employed in obstetrics and gynaecology. These two groupings represented 7.9% of the
nursing workforce. There is no trend data available on the number of midwives but
information provided by several State/Territory health departments indicated the number
was declining. More information is provided on midwife numbers in Appendix J.
62
AMWAC 1998.6
BALANCING SUPPLY AGAINST REQUIREMENTS

Requirement Trends
The Working Party assessed various indicators of future obstetrics and gynaecology
requirements. These included: female population growth; birth rates; crude birth rates;
fertility rates; cancer of the cervix, uterus and ovary incidence rates; and trends in
obstetrics and gynaecology national hospital morbidity data and Medicare services.
Australian female population growth: Over the next ten years, the total Australian female
population is expected to increase at an annual rate of 1.1% per annum. During the
same period it is expected that the female population aged 15 years and over will
increase by 1.1% per annum, those aged 15-49 years will increase by approximately
0.3% per annum, and those aged 25 years and over will increase by approximately
1.0% per annum (ABS 3222.0)
Birth rate: There has been a growth in births in Australia from 243,408 live births in 1986
to 253,834 in 1996, this represents a growth of 4.3%, or 0.4% per annum. Future
projections indicate that birth rates will remain constant (ABS Births 1996, 3301.0).
Fertility rate: The total fertility rate since 1992 (1.894) has steadily declined, with the
fertility rate for registered births at 1.796 in 1996, the lowest rate on record. The fertility
rate is considered to be more likely to fall or remain stable in the longer term, and the
age distribution will continue to change in favour of ages over 30 years (ABS Births
1996, 3301.0).
Incidence of cervical, uterine and ovarian cancer (per 100,000): Birth rate and fertility
rate can be used to give an indication of likely future obstetrics requirements. Useful
indicators of likely future gynaecological requirements are less readily available. The
Working Party used the trend in the incidence of cervical, uterine and ovarian cancer as
a proxy indicator for gynaecological service trends. The incidence rate of cancer of the
uterus is increasing in Australia with the incidence rate at 11.85 in 1989 projected to
14.86 in 1999, an increase of 1.6% per annum. Whereas the incidence rate of ovarian
cancer is marginally declining in Australia with the incidence rate 11.10 in 1989 to a
projected 10.93 in 1999 (a decrease of 0.1% per annum) as is the incidence rate of
cervical cancer which indicated an average annual decline of 1.3% between 1983 and
1994.
Medicare and ICD-9-CM data: Medicare obstetrics and gynaecology services provided
by obstetricians and gynaecologists have shown a 2.7% per annum growth over the
period 1986-87 to 1996-97.
63
AMWAC 1998.6
ICD-9-CM data on obstetrics and gynaecology have indicated that for gynaecological
procedures there will be overall growth of 14.0% over the next 20 years (1998-2018) or
0.7% per annum. For obstetrical procedures it is forecasted to rise by only 2.2% or by
0.1% per annum in the same period.
In projecting requirements the Working Party chose not to use Medicare data because it
only covers private practice billing activity; with only a minority of the population with
private health insurance and with that minority declining.
Accordingly, with the exception of the Medicare data, all the indicators were projected
over the period 1999 to 2009. Table 31 below shows projected requirements for
obstetrics and gynaecology, using each of the main indicators.
The projections have been converted to hours per week using the average hours
worked figure of 60 hours per week. Conversion of the data to hours of service allows
comparisons to be made with projected supply data, which is similarly adjusted and
converted. It is also recognised that a ten year projection period is a long time frame for
assumptions to be remain valid. However, this time frame was chosen because five
years was considered to be too short for any impact on training numbers to move
through, given that the training program is six years in duration.
Table 31: Projected requirements for obstetrics and gynaecology services (in full time equivalent
a
hours per week) for selected indicators , 1999 to 2009
Year
Cancer
incidence
Fertility
rates
Birth
rates
Female
pop.
15-49 yrs
ICD-9-CM
Female
pop.
growth >15
years
Female
pop.
growth >25
years
Female pop.
growth
>49 years
1999
56,686
57,041
57,513
57,522
57,647
57,943
58,097
58,685
2000
56,105
56,811
57,755
57,773
58,025
58,621
58,934
60,133
2002
54,962
56,355
58,241
58,279
58,788
60,002
60,645
63,138
2004
53,842
55,901
58,732
58,789
59,561
61,415
62,405
66,292
2006
52,745
55,452
59,226
59,304
60,344
62,862
64,216
69,604
2008
51,670
55,006
59,725
59,823
61,137
64,343
66,079
73,082
2009
51,141
54,784
59,976
60,084
61,538
65,096
67,031
74,885
Note: a - assumes an average of 60 hours worked per week

Source: AMWAC
64
AMWAC 1998.6
The Working Party concluded that the birth rate provided the best indicator of likely
future obstetrics and gynaecology services requirements, that is requirements growth of
an estimated 0.4% per annum. This projection trend is lower than most of the population
trends, but higher than the fertility rate and the incidence of cancer trend. It is actually
close to the trend in growth in obstetrics and gynaecology ICD-9-CM national hospital
morbidity data. Accordingly, the choice of 0.4% represents roughly the mid point of all
the indicators examined, and can be considered a conservative choice.
Supply Trends
The supply of obstetric and gynaecology specialists was projected by ageing the
RACOG specialist numbers through each year of age, subtracting expected retirements
and attrition due to deaths and specialists leaving the workforce and adding expected
new graduates. Importantly, supply trends over the next ten years will be dominated by
the large cohort of specialists aged 55 years and over proceeding through to retirement
and to a lesser extent by the influx of a comparatively large number of female
graduates.
The number of specialists was converted to hours per week by applying the average
number of hours worked to headcounts in each major age cohort. In doing so the
Working Party assumed that the pattern of workforce participation of the current
workforce provides a suitable basis on which to project future workforce requirements.
In addition, the increasing female participation and the average lower lifetime workforce
contribution of female specialists has been assumed. The supply projections show that
supply will increase from the estimated current level of 57,272 FTE hours per week to
an estimated 59,260 FTE hours per week in 2009, assuming average retirements; with
an upper and lower projection range of 58, 084 FTE hours and 62,025 FTE hours per
week respectively (Table 32).
Table 32: Projected supply of obstetrics and gynaecology services, high, low and average
retirement rates, by FTE hours worked per week, 1999, 2004 and 2009
Year
Low retirement rate
Average retirement rate
High retirement rate
1999
56,968
57,191
57,414
2004
56,309
57,359
58,469
2009
58,084
59,260
62,025
Source: AMWAC
Using average retirement rates, current workforce supply, average hours worked per
week and graduate output, future supply projections indicate that the workforce will fall
slightly below the estimated obstetrics and gynaecology service requirements levels
growth of 0.4% per annum, representing an estimated 0.6% shortage in 1999, an
65
AMWAC 1998.6
estimated 2.7% shortage in the year 2000 and an estimated 2.4% in the year 2004
(Table 33).
Table 33: Projected obstetrics and gynaecology supply and requirements (FTE hours), 0.4% growth
per year, 1998 to 2004a
Year
Projected supply
Projected requirements
% shortage
1998
57,272
57,272
base year
1999
57,191
57,513
0.6
2000
56,220
57,755
2.7
2002
56,603
58,241
2.9
2004
57,359
58,732
2.4
Note: a - based on average retirement rates, a working week of 60 hours and constant intake of trainees
per annum
Source: AMWAC
Projected Balance
A balance in supply to match a continued growth rate in the requirement indicators of
0.4% per annum can be achieved by ensuring the same number of graduates currently
entering the six year program is maintained; that is a trainee intake of 58 per year. This
assumes that the length of the RACOG training program would continue to be six years
and that all candidates will complete the program within this time frame. This
assumption has been necessary in the absence of data from RACOG on average
training program completion times. In part, this reflects the difficulty of knowing what, if
any, impact on completion will be caused by the increase in female trainees and the
introduction of part time training arrangements.
If trainee intakes achieve 58 per year, it is expected that there will be no significant
shortfall emerging in the workforce. Table 34 shows the obstetrics and gynaecology
trainee output needed, to move projected supply into balance with projected
requirements for this workforce. The projected requirement used is based on 0.4%
growth per year. Under this scenario notional shortages are expected to peak at 2.9%
in 2002 but for requirements and supply to move back towards balance thereafter. It is
projected that there will only be 1.6% shortfall in 2008.
66
AMWAC 1998.6
Table 34: Obstetrics and gynaecology graduate output needed to move projected supply into
balance with projected requirements, 0.4% growth per year, (in FTE hours), 1998 to 2009
Year
Number of
graduates
Projected
supply
Projected
requirements
Balance
(shortage)
% shortage
1998
45
57,272
57,272
base year
0.0
1999**
21
57,191
57,513
322
0.6
2000
50
56,220
57,755
1,534
2.7
2001
47
56,466
57,997
1,531
2.7
2002
57
56,603
58,241
1,638
2.9
2003
49
57,153
58,486
1,333
2.3
2004
42
57,359
58,732
1,372
2.4
2005**
58
57,244
58,978
1,734
3.0
2006
58
57,764
59,226
1,462
2.5
2007
58
58,272
59,475
1,203
2.1
2008
58
58,770
59,725
955
1.6
2009
58
59,260
59,976
717
1.2
*Training period is six years ** Constant trainee intake beginning 1999 and graduating in 2005
Source: AMWAC
Table 34 is shown graphically in figures 1 and 2 below. Figure 1 includes all demand
indicators: female population growth greater than 15 years of age, female population
growth in the 15 to 49 year age group, female population growth greater than 25 years
of age, birth rates, crude birth rates, fertility rates, female reproduction rate and cancer
cervix index and projected trends in ICD-9-CM, plotted against the workforce supply
using graduating trainee figures (Table 32) in FTE demand hours per week to the year
2009. Figure 2 shows the workforce supply versus the demand indicators for birth rates
and fertility rates in FTE demand hours per week to the year 2009.
67
AMWAC 1998.6
80,000
70,000
FTE hours per week
60,000
50,000
Population growth
Female population growth (>15y rs)
Female growth in the 15-49 age group
Female population growth >25
Birth rates
Fertility rates
ICD-9-CM
Female population growth > 49
c anc er c ervix index (20 to 74)
W orkforc e (FTEs hrs/week)
40,000
30,000
20,000
10,000
-
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year
61,000
60,000
59,000
58,000
57,000
56,000
55,000
B irth rates
54,000
Fertility rates
53,000
W orkforc e (FTE s hrs/week)
52,000
1998
1999
2000
2001
2002
2003
68
2004
2005
2006
2007
2008
2009
AMWAC 1998.6
Ideally trainee intake should be around 58 per year so that no significant shortfall
emerges in the workforce. However, RACOG has indicated that the initial intake of 58
trainees per year may not be achievable as there are limited potential training positions
currently available and an already stretched resource of trainers. Maintenance of trainee
intake at this level could also impact on trainees obtaining the necessary accumulated
training experience. Accordingly, to accommodate this concern several scenarios based
on trainee intake ranging from 50 per year to 58 per year were examined and the results
are summarised in Table 35. Notional shortfalls range from a near balanced scenario
with a trainee intake of 58 per year to an estimated shortfall of 3.6% with a trainee
intake of 50 per year.
In recognition of RACOGs concern the Working Party has recommended that an intake
of 55 trainees per year, which in fact is similar to the trainee intake over the period 1995
to 1997, is a more practical target to aim for as this should lessen any impact in terms of
available trainers and accumulation of clinical experience by trainees.
A trainee intake of 55 per year, will produce an estimated workforce shortfall of 2.1% in
2009. The Working Party believes that there will be no emerging shortage of obstetrics
and gynaecology specialists if the trainee intake is set at 55 per year. Of course this
does not address the issue of maldistribution of the workforce and in this respect it will
be necessary for RACOG and State/Territory health departments to make internal
adjustments to the distribution of training positions.
69
AMWAC 1998.6
Table 35: Estimated obstetrics and gynaecology graduate output required to move projected
supply into balance with projected requirements, 0.4% growth per year, (in FTE hours), by selected
graduate outputs, 1998 to 2009
Year
2005
2006
2007
2008
2009
59,226
59,475
59,725
59,976
Projected requirements
58,978
Projected supply for 50 graduates per year, beginning in 1999 and graduating in 2005
57,244
57,428
57,591
57,736
57,870
1,734 (3.0%)
1,798 (3.1%)
1,885 (3.3%)
1,989 (3.4%)
2,106 (3.6%)
Balance (shortage)
57,244
57,512
57,761
57,995
58,217
1,734 (3.0%)
1,714 (3.0%)
1,714 (3.0%)
1,731 (3.0%)
1,759 (3.0%)
Balance (shortage)
57,244
57,638
58,016
58,382
58,739
1,734 (3.0%)
1,588 (2.8%)
1,459 (2.5%)
1,343 (2.3%)
1,238 (2.1%)
Balance (shortage)
57,244
57,764
58,272
58,770
59,260
1,734 (3.0%)
1,462 (2.5%)
1,203 (2.1%)
955 (1.6%)
717(1.2%)
Balance (shortage)
Source: AMWAC
The Working Party recommends that training positions should be increased

proportionately less in the comparatively well endowed state of South Australia, and to a
lesser extent Victoria, although it needs to be remembered that Victoria has a significant
proportion of older specialists. This is also the case in New South Wales. In particular,
emphasis needs to be given to increasing training positions in New South Wales,
Western Australia and Queensland. The Working Party recommends that the training
positions up to the year 2002 should be distributed as shown below in Table 36. Table
36 also shows the actual intake level for 1997 and 1998.
70
AMWAC 1998.6
Table 36: Distribution of obstetrics and gynaecology first year advanced trainee positions, by
State/Territory
1997
1998
1999
actual intake
2000
2001
2002
required intake
NSW
18
14
20
20
20
20
Victoria
12
10
14
14
13
12
Queensland
11
11
11
11
South Australia
Western Australia
Tasmania
ACT
Northern Territory
49
42
55
55
55
55
Australia
Source: AMWAC
Given the sensitivity of the assumptions in the projection modelling, it will be important
that obstetrics and gynaecology requirements and supply projections be monitored
regularly so that they can be amended if new trends emerge. The Working Party
recommends that a review of the specialist obstetrics and gynaecology workforce be
undertaken before the level of trainee intake for 2003 is determined, that is by the end of
2000. In this context, it will also be important for AMWAC to continue to monitor the
trend in the numbers of non specialist providers.
It should also be noted that whilst RACOG has recently introduced a compulsory six
month rural training placement for trainees, in an effort to improve awareness of rural
practice, this scheme will need the continued support of State/Territory health
departments in terms of funding and support of suitable rural training positions.
The Working Party would also like the Commonwealth and State/Territory health
departments to consider the establishment of rural cadetships aimed at providing
financial assistance to those training in their last year and are interested in remaining
and establishing a rural practice. This process coupled with the compulsory experience
to rural practice through the training program may help to alleviate some of the
geographical maldistribution inherent in the workforce. In the first instance the
Commonwealth Department of Health and Family Services and RACOG should jointly
examine the feasibility of such a scheme.
71
AMWAC 1998.6
RECOMMENDATIONS
The Working Party recommends:
1.
There be an increase in the number of funded obstetrics and gynaecology

training positions to maintain trainee intake during the period 1999 to 2002 at 55
per year.
2.
That State and Territory health departments undertake negotiations with the
RACOG to ensure intake numbers for first year trainees remain constant at 55
per year to 2002 and distributed as shown below.
Distribution of obstetrics and gynaecology first year advanced trainee positions, by
State/Territory
1997
1998
1999
actual intake
2000
2001
2002
required intake
NSW
18
14
20
20
20
20
Victoria
12
10
14
14
13
12
Queensland
11
11
11
11
South Australia
Western Australia
Tasmania
ACT
Northern Territory
49
42
55
55
55
55
Australia
Source: AMWAC
3.
State/Territory based obstetrics and gynaecology services working groups,

comprising RACOG and State/Territory department of health representatives, be
organised to oversee the funding and establishment of any new training
positions.
4.
That obstetrics and gynaecology requirements and supply projections be

monitored regularly so that they can be amended if new trends emerge, and that
the specialist obstetrics and gynaecology workforce be reviewed before the level
of trainee intake for 2003 is decided, that is at the end of 2000.
72
AMWAC 1998.6
5.
That this monitoring be coordinated by RACOG and AMWAC and the results
incorporated into the AMWAC annual report to AHMAC. AMWAC will provide all
necessary support.
6.
AMWAC also to continue to monitor the trend in the numbers of non specialist
obstetric and gynaecology providers (general practitioners and midwives).
7.
The RACOG and the Commonwealth Department of Health and Family Services
examine the feasibility of establishing a rural obstetric and gynaecology graduate
cadetship scheme to encourage graduates from the obstetrics and gynaecology
training program to consider rural practice.
73
AMWAC 1998.6
PART B:
THE OBSTETRICS AND GYNAECOLOGY
SUB-SPECIALIST WORKFORCE
74
AMWAC 1998.6
INTRODUCTION
As indicated in the Introduction to the main, part A, report, the Working Party decided
that the various obstetrics and gynaecology sub specialist workforces should also be
examined in some detail. There are five obstetrics and gynaecology sub specialties maternal fetal medicine, uro-gynaecology, obstetrical and gynaecological ultrasound,
gynaecological oncology and reproductive endocrinology and infertility.
The main data sources used in preparing this section of the report where the RACOG
information on Fellows and trainees and the RACOG/AMWAC survey of Fellows. Where
available data from the AIHW Medical Labour Force Survey and Medicare has also
been used. It should also be noted that the 98 sub specialists identified by the RACOG
and the Working Party are not in addition to the 1,049 obstetrics and gynaecology
specialists identified in part A of this report as the total specialist workforce, rather they
are part of that total.
Sub-specialist Definitions
The Working Party defined a gynaecological oncology specialists as:
A Gynaecological Oncologist is a FRACOG who has completed a formal three
year training program in gynaecological cancer care and passed the examination
for Certified Gynaecological Oncologist. She/he is competent in the
comprehensive management of the women with a genital malignancy. The subspecialist will work in gynaecology with at least 66% of the time in gynaecological
oncology. She/he will submit themselves for reaccreditation every five years, and
only those actively practising will continue to be accredited.
The aims of sub-specialisation are to: improve the education and skills of those
treating women with genital malignancy; improve outcomes for these women;
promote research into the management of these diseases; ensure that women
receive the highest standards of care; and, to ensure that all women have access
to sub-specialist care in the management of gynaecological cancer.
The Working Party defined a sub-specialist in maternal fetal medicine as :
A specialist in obstetrics and gynaecology, possessing the FRACOG, who is
trained and assessed as being competent in the comprehensive management in
obstetrical, medical and surgical complications of pregnancy and their effect on
both the mother and fetus. It requires expertise in the most current approaches
to diagnosis and treatment of patients with complicated pregnancies and also
requires a setting where requisite technical support is available. Personnel with
advanced knowledge of newborn adaptation also are necessary to ensure a
continuum of excellence in care from the fetal to newborn periods.
75
AMWAC 1998.6
A sub-specialist in this field should spend the majority of their time in clinical work
and have a practice profile that demonstrates in excess of 80% of clinical time is
spent in this specialty area. Such a person must have a full time tertiary base
which satisfies the definition of a Maternal Fetal Medicine Unit. Activities
conducted outside this base may be permitted where the primary purpose is
teaching, research or administration in fields related to maternal-fetal medicine.
To maintain status as a specialist the practitioner would need to remain affiliated
with a hospital providing the facilities of a tertiary referral perinatal centre.
The Working Party defined a sub-specialist in obstetrical and gynaecological ultrasound
specialists as:
A Sub-specialist in Obstetrical and Gynaecological Ultrasound is a Fellow in good
standing of RACOG who is trained and has been assessed as being competent
in all aspects of ultrasound diagnosis relating to obstetrics and gynaecology
including ultrasound guided interventional diagnostic and therapeutic techniques.
Such an individual would spend of at least 22 hours per week in obstetrical and
gynaecological diagnostic ultrasound practice. It is desirable but not mandatory
that he/she work part of this time in a tertiary care institution where the ultrasound
department provides a comprehensive diagnostic service to general obstetrics
and gynaecology and to the sub-specialties.
The Working Party defined a sub-specialist in reproductive endocrinology and infertility
as :
A gynaecological sub-specialist in Reproductive Endocrinology and Infertility is a
specialist in obstetrics and gynaecology, possessing the FRACOG, who is trained
and assessed as being competent in the comprehensive management of patients
with reproductive endocrine disorders and infertility. His or her continued medical
activity may be in gynaecology and/or obstetrics, but with at least 67% of his or
her clinical time being spent in the area of reproductive endocrinology and/or
infertility. At least part of this work must be within a professional setting that
provides a comprehensive service for patients with infertility or gynaecological
endocrine disorders. This may include private units as well as public hospitals.
The Certificate of Reproductive Endocrinology and Infertility (CREI) is recognised
by the National Specialist Qualification Advisory Committee as a registrable
degree only for individuals who hold the qualification of Fellow of the Royal
Australian College of Obstetricians and Gynaecologists (FRACOG). It is not
intended that only persons with their CREI should treat infertile couples. It is
probable, though, that leaders in this area and directors of assisted conception
units will have this qualification.
76
AMWAC 1998.6
The Working Party defined a sub-specialist in uro-gynaecology as:

A specialist in obstetrics and gynaecology, possessing the FRACOG, who is
trained and assessed as being competent in the comprehensive management of
patients with uro-gynaecological disorders. Continued medical activity may be in
gynaecology and/or obstetrics, but with at least 50% of their time spent in the
area of uro-gynaecology.
All the sub-specialist certificates are recognised by the National Specialist Qualification
Advisory Committee as a registrable degree only for individuals who hold the
qualification of FRACOG.
77
AMWAC 1998.6
CHARACTERISTICS OF THE OBSTETRICS AND GYNAECOLOGY SUBSPECIALTY WORKFORCE

Number of Practising Sub-specialists in Obstetrics and Gynaecology
The current size of the practising obstetrics and gynaecology sub-specialist workforce is
estimated to be 98. The number of sub-specialists is relatively small, making up
approximately 9.3% per cent of the profession.
The estimated numbers within each of the five sub-specialties are 10 maternal fetal
medicine specialists, 13 uro-gynaecologists, 23 obstetrical and gynaecological
ultrasound specialists, 24 gynaecological oncology specialists and 28 reproductive
endocrinology and infertility specialists.
Distribution of the Sub-specialist Workforce
Table 37 shows the sub-specialties by State/Territory and indicates that 38.8% of all
sub-specialties are located in New South Wales with none in the Northern Territory.
Table 38 shows the geographic distribution of sub-specialists and indicates that the
majority (91.8%) are located in capital cities. Only obstetrics and gynaecology
ultrasound is represented in rural centres (1.0%). 7.2% of sub-specialists are located in
other metropolitan areas (16.8% of the female population).
78
AMWAC 1998.6
Table 37: Number of obstetrics and gynaecology sub-specialists, by sub-specialty, State/Territory

and gender, 1998
NSW
Vic
Qld
SA
WA
Tas
ACT
NT
Aust
Gynaecological oncology
Males
23
Females
Total
24
Maternal fetal medicine

Males
Females
Total
10
Obstetrical and gynaecological ultrasound

Males
10
19
Females
Total
12
23
Reproductive endocrinology and infertility

Males
Females
Total
12
26
14
28
Uro-gynaecology
Males
12
Females
Total
13
All obstetrics and gynaecology sub-specialists

Males
34
25
11
87
11
38
27
13
98
% distribution
38.8
27.6
8.2
8.2
13.2
2.0
2.0
0.0
100.0
% female
10.5
7.4
12.5
25.0
15.4
0.0
0.0
0.0
11.2
Females
Total
Source: RACOG
79
AMWAC 1998.6
Table 38: Distribution of obstetrics and gynaecology sub-specialists; by geographic location, 1998
State/Territory
Total
% of
Australia
% capital city
% other
metro.
% large
rural
centre
% small
rural
centre
Gynaecology
Oncology
24
24.5
100.0
0.0
0.0
0.0
Maternal Fetal
Medicine
10
10.2
80.0
20.0
0.0
0.0
Obstetrics and
Gynaecology
Ultrasound
23
23.5
87.0
8.7
4.3
0.0
Reproductive
Endocrinology &
Infertility
28
28.6
89.3
10.7
0.0
0.0
Uro-gynaecology
13
13.3
100.0
0.0
0.0
0.0
Australia
98
100.0
91.8
7.2
1.0
0.0
Source: RACOG
Age Profile
The youngest sub-specialist was aged 35 years and the oldest were aged between 66
and 70 years, with a mean age of 46.5 years.
The largest five year age groups were the 46 to 50 year age group (24.5%), and the 41
to 45 year age group (23.5%). Nine individuals (9.2%) are aged over 60 years.
In Victoria, 18.5% (5) of the total sub-specialists were aged over 60 years. Queensland
had the youngest group (under 50 years of age) of specialists in the workforce
representing 87.5% (7) followed by New South Wales at 63.2% (24).
For all sub-specialties the majority of individuals were aged under 50 years, that is, 90%
(9) of maternal fetal medicine specialists, 61.5% (8) uro-gynaecology specialists, 65.2%
(15) obstetrical and gynaecological ultrasound specialists, 62.5% (15) gynaecological
oncology specialists and 50% (14) reproductive endocrinology and infertility specialists.
80
AMWAC 1998.6
Table 39: Age profile of obstetrics and gynaecology sub-specialists, by State/Territory and gender,
1998
State/Terr. Sex
NSW
Vic
Qld
SA
WA
Tas
NT
ACT
Australia
31-35
yrs
36-40
yrs
41-45
yrs
46-50
yrs
51-55
yrs
56-60
yrs
34
25
11
10
16
23
19
87
11
12
23
24
20
98
0.0
16.7
30.4
4.2
5.0
0.0
0.0
0.0
0.0
11.2
Total
% female
Source: RACOG
61-65 66-70
yrs
yrs
71+ Total
yrs
Table 40 provides a summary of the sub-specialists by major age categories. It shows

that for Australia, 62.2% (61) of sub-specialists were aged less than 50 years, and 9.2%
(9) were aged over 60 years. The sub-specialist workforce is predominantly under 50
years of age.
81
AMWAC 1998.6
Table 40: Age profile of obstetrics and gynaecology sub-specialists, by State/Territory, gender and
major age group, 1998
State/Terr
Sex
under 50 years
20
14
51
10
12
27
38
27
13
98
51-60 years
over 60 years
Total
NSW
Vic
Qld
SA
WA
Tas
NT
ACT
Aust
Source: RACOG
Gender Profile
Women represent 11.2% (11) of the sub-specialist workforce (Table 39). The largest
proportion of female sub-specialists is in the 41 to 45 year age group (30.4%) followed
by the 36 to 40 year age group (16.7%).
Hours Worked
Table 41 details the average hours provided by obstetrics and gynaecology subspecialists by State and Territory. The average hours worked per week by subspecialists was 64.2, 42.3 hours per week were worked in direct patient care and an
average of 13.4 hours per week were worked on call.
82
AMWAC 1998.6
Table 41: Sub-specialists in obstetrics and gynaecology average hours worked per week and
annual labour supply hours, by State/Territory, 1998
State/Terr.
NSW
Vic
Qld
SA
WA
Tas
ACT
NT
Total
Total hours worked

Average
Annual hours
hrs worked
per 100,000
female pop
69.5
63.1
54.0
64.8
60.0
70.0
54.0
64.2
121,486
78,370
19,872
23,846
35,880
6,440
4,968
289,414
4,892
4,247
1,519
3,978
5,225
3,418
4,075
3,967

Average
40.5
48.4
35.2
36.2
53.3
40.0
20.0
42.3
Annual hours
70,794
60,113
12,954
13,322
31,873
3,680
1,840
190,688
hrs worked
per 100,000
female pop
2,851
3,257
990
2,222
4,642
1,953
1,509
2,614

Average
Annual hours
hrs worked
per 100,000
female pop
19.8
16.7
1.7
2.0
0.0
0.0
4.0
13.4
34,610
20,741
626
736
0.0
0.0
368
60,407
911
768
78
92
0.0
0.0
184
616

Average
63.8
23.0
6.0
58.0
0.0
0.0
24.0
38.3
114,457
24,334
2,208
21,344
0.0
0.0
2,208
172,656
hrs worked
per 100,000
female pop
2,935
1,058
276
2,668
0.0
0.0
1,104
1,762
Female pop
>15 years
(>000)
2,483.2
1,845.4
1,308.0
599.4
686.7
188.4
121.9
62.6
7,296.6
Annual hours
Source: RACOG/AMWAC Survey 1997
Table 42 details the average hours provided by sub-specialists by gender and age. In
1997 sub-specialists worked on average 64.2 hours per week, 62.6 for males and 77.6
for females. However, those under 55 years of age averaged around 66.6 hours per
week; this declined to 58.4 hours for males in the 55 to 64 years age group, and 51.3
hours for males in the 65 to 70 years age group.
83
AMWAC 1998.6
Table 42: Sub-specialists in obstetrics and gynaecology average hours and annual hours worked,
by gender and age group, 1998
Gender
35-44 yrs
45-54 yrs
55-64 yrs
65-70 yrs
Total
Total hours worked

Male
60.5
67.4
58.4
51.3
62.6
Female
77.6
77.6
Total
65.8
67.4
58.4
51.3
64.2
111,922
136,418
40,296
4,720
289,414
Annual total hours worked

Male
48.5
42.7
33.3
43.7
42.4
Female
41.6
41.6
Total
46.2
42.7
33.3
43.7
42.3
78,632
86,425
22,977
4,020
190,688
Annual direct hours worked

Male
38.8
41.8
16.8
0.0
33.9
Female
58.4
58.4
Total
48.6
41.8
16.8
0.0
38.3
82,717
84,603
11,592
172,656
Annual hours on call not worked

Male
Female
Total
Annual hours on call worked
No. of sub-specialists
31.0
3.3
32.6
0.0
15.2
4.3
4.3
18.9
3.3
32.6
0.0
13.4
32,168
6,679
22,494
0.0
60,407
37
44
15
98
(a) Calculated as average hours multiplied by persons multiplied by 46 weeks per year
The RACOG/AMWAC survey indicated that the average hours worked by subspecialists varied by region with the average hours in direct patient care in major urban
areas at 42.5 hours a week compared to 32.0 hours a week in large rural centres.
64.5% of sub-specialists from major urban centres reported being on call for after hours
worked as is shown in Table 43.
84
AMWAC 1998.6
Table 43: Sub-specialists in obstetrics and gynaecology average hours worked per week, by
geographic location of main job, 1997
Major urban centre
Provincial/ rural
town
Total
Total hours worked
65.3
32.0
64.2
42.5
32.0
42.3
13.9
0.0
13.9
39.7
0.0
38.3
64.5
0.0
64.5
50
44
50
Average age
Practice Profiles
The majority (58.3%) of sub-specialists worked as solo specialists, 18.6% worked with
other obstetricians and gynaecologist and 16.7% worked with a multi-disciplinary group
and the remaining 6.4% made no response.
Of the 48 sub-specialists from the RACOG/AMWAC Survey, 41.7% were in a private
practice and/or undertake public hospital work; 31.3% were salaried in a public hospital;
16.7% were in a private practice with no public hospital role; 4.2% were public hospital
salaried and in a private practice and 6.1% made no response.
There were 45 sub-specialists respondents who indicated their appointment by
State/Territory. The proportion reporting employment in public hospitals was much
higher in New South Wales (46.7%) and lower (6.7%) in the Australian Capital Territory.
There was no public hospital representation in Western Australia, Tasmania and the
Northern Territory (Table B11, Appendix B).
RACOG offers certificates in each of the five sub-specialties. With the exception of
obstetrical and gynaecological ultrasound each of the sub-specialty training programs
are of three years duration. The ultrasound training is a two year program. Sub-specialty
trainees by age group and year of training is shown in Table 44. There are 17 (43.6%)
female sub-specialist trainees, the majority (23.5%) of which are aged under 40 years.
85
AMWAC 1998.6
Table 44: Obstetrics and gynaecology sub-specialty trainees, by year of training, gender and major
age group, February 1998
Sub-specialty trainees
Sex 31-35 yrs 36-40 yrs 41-45 yrs 46-50 yrs Total
Year 1
Year 2
Year 3
Completed clinical training but not all assessment
requirements
Total
Maternal-Fetal Medicine
Year 1
Year 2
Year 3
Completed clinical training but not all assessment
requirements
Total
Obstetrical and Gynaecological Ultrasound (2 year program only)

Year 1
Completed clinical training but not all assessment M

requirements
F
Total
Reproductive Endocrinology and Fertility

Year 1
Year 2
Year 3

requirements
F
Total
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AMWAC 1998.6
Uro-gynaecology
Year 1

requirements
F
Year 2
Year 3
Total
Total Sub-specialists
22
39
33.3
45.5
50.0
50.0
43.6
% Females Sub-specialists
Source: RACOG
Currently there are no sub-specialty trainees in the Australian Capital Territory, the
Northern Territory, Tasmania and Western Australia. Trainees in their last year
represent 20.5% of the total trainee numbers.
Table 45: Obstetrics and gynaecology sub-specialty trainees, by State/Territory and gender,
February 1998
Sex
NSW
ACT
Vic
Qld
SA
WA
NT
TAS
OS
Total
No. in 3rd Clinical training

year
M
Maternal-Fetal Medicine

2
1
Reproductive Endocrinology and Infertility

1
Uro-gynaecology
M
10
44
12
18
60.0
16.7
50.0
20.0
40.9
55.6
41.7
Sub-specialist total
19
Female sub-specialist total

8
Female sub-specialist %
42.1
* Obstetrical and gynaecological ultrasound is a two year program

Source: RACOG
87
AMWAC 1998.6
Obstetrics and Gynaecology Sub-Specialist:Population Ratios

Table 46 indicates the five sub-speciality ratios by State and Territory for the female
population age ranges. The sub-specialist:population ratio (SSPR) are based upon the
1998 number of sub-specialists in the workforce. The number of sub-specialists per
100,000 population indicates the current level nationally.
The RACOG sub-specialist committees have indicated the following subspecialist:population ratio (SSPR) benchmarks for females. For gynaecological
oncologist 0.4 per 100,000; 0.33 per 100,000 for maternal fetal medicine sub-specialists;
0.4 per 100.000 for sub-specialists in ultrasound; 2 per 100,000 for sub-specialists in
reproductive endocrinology and infertility and 0.32 per 100,000 for uro-gynaecologists.
No national SSPR benchmark has been derived, however, Table x shows that the
current national SSPR for females aged greater than 15 years in Australia is estimated
at 1:72,955 or 1.4 per 100,000 population. State/Territory provision ranged from 0 per
100,000 population in the Northern Territory to 1.9 per 100,000 population in Western
Australia.
The gynaecological oncology SSPR for females aged 15 years and greater in Australia
is estimated at 1:303,979 or 0.3 per 100,000 population. The RACOG Gynaecological
Oncology Committee recommends an acceptable SSPR for the Australian female
population as 0.4 per 100,000 population. State/Territory provision ranged from 0 per
100,000 population in the Territories to 0.5 per 100,000 population in Tasmania.
Western Australia is also in line with the Committees recommended benchmark.
The maternal fetal medicine SSPR for females aged 15 to 49 years in Australia is
estimated at 1:665,200 or 0.2 per 100,000 population. The RACOG Maternal Fetal
Medicine Committee has estimated an acceptable SSPR as 0.33 per 100,000
population. State/Territory provision ranged from 0 per 100,000 population in the
Northern Territory, Tasmania South Australia, Queensland and Victoria to 2.2 per
100,000 population in the Australian Capital Territory.
The ultrasound SSPR for females aged 15 years and greater in Australia is estimated at
1:383,973 or 0.3 per 100,000 population. The RACOG Ultrasound Committee has
estimated an acceptable SSPR as 0.4 per 100,000. State/Territory provision ranged
from 0 per 100,000 population in the Northern Territory, Tasmania, and the Australian
Capital Territory to 0.5 per 100,000 population in Victoria.
The reproductive endocrinology and infertility SSPR for females aged 15 to 49 years in
Australia is estimated at 1:179,092 or 0.6 per 100,000 population. The RACOG
Reproductive Endocrinology and Infertility Committee has estimated an acceptable
SSPR as 2 per 100,000 population. State/Territory provision ranged from 0 per 100,000
population in the Territories to 1.1 per 100,000 population in South Australia. All
88
AMWAC 1998.6
States/Territories fell below the Committee SSPR level.

The uro-gynaecology SSPR for females aged 25 years and greater in Australia is
estimated at 1:590,510 or 0.2 per 100,000 population. The SSPR for the Australian
female population that has been recommended by RACOG as 0.32 per 100,000.
State/Territory provision ranged from 0 per 100,000 population in the Australian Capital
Territory and the Northern Territory, Tasmania and Queensland to 0.7 per 100,000
population in Western Australia. New South Wales and South Australia are also in line
with the RACOG benchmark.
89
AMWAC 1998.6
Table 46: Sub-specialists in obstetrics and gynaecology female population: population ratio, by
NSW
Vic
Qld
SA
WA
Tas
ACT
NT
Total
38
27
13
98
2,483.2
1,845.4
1,308.0
599.4
686.7
188.4
121.9
62.6
7,295.7
65.3
68.3
163.5
74.9
52.8
94.2
60.9
72.9
1.5
1.5
0.6
1.3
1.9
1.1
1.6
0.0
1.4
Total number of sub-specialists

Number
Pop A (x 1000)
SPR:1x1000
No. per 100,000
Number
Pop A (x 1000)
SPR:1x1000
No. per 100,000
24
2,483.2
1,845.4
1,308.0
599.4
686.7
188.4
121.9
62.6
7,295.7
310.4
307.6
327.0
299.7
228.9
188.4
304.0
0.3
0.3
0.3
0.3
0.4
0.5
0.0
0.0
0.3
Maternal Fetal Medicine

Number
Pop B (x 1000)
SPR:1x1000
No. per 100,000
1,552.1
1,159.7
865.3
364.9
456.4
117.7
87.5
52.8
4,656.4
388.0
456.4
43.7
665.2
0.3
0.0
0.0
0.0
0.2
0.0
2.2
0.0
0.2

Number
Pop A (x 1000)
SPR:1x1000
No. per 100,000
10
19
2,483.2
1,845.4
1,308.0
599.4
686.7
188.4
121.9
62.6
7,295.7
496.6
184.5
654.0
343.4
383.9
0.2
0.5
0.2
0.0
0.3
0.0
0.0
0.0
0.3
Reproductive Endocrinology and Infertility

Number
Pop B (x 1000)
SPR:1x1000
No. per 100,000
12
26
1,552.1
1,159.7
865.3
364.9
456.4
117.7
87.5
52.8
4,656.4
129.3
165.7
865.3
91.2
456.4
117.7
179.1
0.8
0.6
0.1
1.1
0.2
0.8
0.0
0.0
0.6
Uro-gynaecology
Number
Pop C (x 1000)
SPR:1x1000
No. per 100,000
12
2,048.4
1,458.6
1,099.4
486.6
551.0
150.6
92.9
55.6
5,905.1
402.1
729.3
0.0
486.6
137.8
492.1
0.2
0.1
0.0
0.2
0.7
0.0
0.0
0.0
0.2
Notes: Pop A - females aged 15 years and greater; Pop B - females aged 15 to 49 years; Pop C - females
aged 25 years and greater. Source: RACOG and ABS 1997
90
AMWAC 1998.6
APPENDIX A:
RURAL,
REMOTE
CLASSIFICATION
AND
METROPOLITAN
AREAS
The Commonwealth Departments of Health and Family Services and Primary Industries
and Energy, Rural, Remote and Metropolitan Areas classification, has been used to
classify the geographic location of the job of responding medical practitioners in the
following seven categories.
Metropolitan areas:
1.
Capital cities consist of the State and Territory capital cities of Sydney,
Melbourne, Brisbane, Perth, Adelaide, Hobart, Darwin and Canberra.
2.
Other metropolitan centres consist of one or more statistical subdivisions which

have an urban centre of population of 100,000 or more in size. These centres
are: Newcastle, Wollongong, Queanbeyan (part of Canberra-Queanbeyan),
Geelong, Gold Coast-Tweed Heads, Townsville-Thuringowa.
Rural zones:
3.
Large rural centres are statistical local areas where most of the population reside
in urban centres of population of 25,000 to 99,999. These centres are: AlburyWodonga, Dubbo, Lismore, Orange, Port Macquarie, Tamworth, Wagga Wagga
(NSW); Ballarat, Bendigo, Shepparton-Mooroopna (Vic); Bundaberg, Cairns,
Mackay, Maroochydore-Mooloolaba, Rockhampton, Toowoomba (Qld), Whyalla
(SA); Launceston (Tas) and Alice Springs (NT).
4.
Small rural centres are statistical local areas in rural zones containing urban
centres of population between 10,000 and 24,999. These centres are: Armidale,
Ballina, Bathurst, Broken Hill, Casino, Coffs Harbour, Forster-Tuncurry,
Goulburn, Grafton, Griffith, Lithgow, Moree Plains, Muswellbrook, NowraBombaderry, Singleton, Taree (NSW); Bairnsdale, Colac, Echuca-Moama,
Horsham, Mildura, Moe-Yallourn, Morwell, Ocean Grove-Barwon Heads,
Portland, Sale, Traralgon, Wangaratta, Warrnambool (Vic); Caloundra,
Gladstone, Gympie, Hervey Bay, Maryborough, Tewantin-Noosa, Warwick (Qld);
Mount Gambier, Murray Bridge, Port Augusta, Port Lincoln, Port Pirie (SA);
Albany, Bunbury, Geraldton, Mandurah (WA); Burnie-Somerset, Devonport
(Tas).
5.
Other rural areas are the remaining statistical areas within the rural zone.
Examples are Cowra Shire, Temora Shire, Guyra Shire (NSW); Ararat Shire,
Cobram Shire (Vic); Cardwell Shire, Whitsunday Shire (Qld); Barossa, Pinnaroo
(SA); Moora Shire, York Shire (WA); George Town, Ross (Tas); Coomalie,
Litchfield (NT).
91
AMWAC 1998.6
Remote zones:
These are generally less densely populated than rural statistical local areas and
hundreds of kilometres from a major urban centre.
6.
Remote centres are statistical local areas in the remote zone containing urban
centres of population of 5,000 or more. These centres are: Blackwater, Bowen,
Emerald, Mareeba, Moranbah, Mount Isa, Roma (Qld); Broome, Carnarvon, East
Pilbara, Esperance, Kalgoorlie/Boulder, Port Hedland, Karratha (WA); Alice
Springs, Katherine (NT).
7.
Other remote areas are the remaining areas within the remote zone. Examples
are: Balranald, Bourke, Cobar, Lord Howe Island (NSW); French Island, Orbost,
Walpeup (Vic); Aurukun, Longreach, Quilpie (Qld); Coober Pedy, Murat Bay,
Roxby Downs (SA); Coolgardie, Exmouth, Laverton, Shark Bay (WA); King
Island, Strahan (Tas); Daly, Jabiru, Nhulunbuy (NT).
92
AMWAC 1998.6
APPENDIX B:
SURVEY OF FELLOWS OF THE ROYAL AUSTRALIAN COLLEGE

OF OBSTETRICIANS AND GYNAECOLOGISTS
METHODOLOGY
To assist with the establishment of a profile of the obstetrics and gynaecology workforce
in Australia, a mailed survey of all RACOG fellows was conducted. The survey was
administered by AMWAC in consultation with the RACOG. 501 Fellows of the RACOG
responded to the questionnaire, which is a response rate of 53%.
RESULTS
Distribution of Respondents
Table B1 shows that the distribution of respondents to the RACOG/AMWAC Survey is
similar to the overall State/Territory distribution of RACOG members and the AIHW
Medical Labour Force Survey (1995). Victoria was the only State with a low
representation of respondents compared to the RACOG membership.
Table B1: Distribution of survey respondents compared to RACOG members and AIHW survey, by
State/Territory
NSW/ACT
Vic
Qld
SA
WA
Tas
NT
Aust
8.8
2.4
0.6
100.0
8.7
2.4
0.7
100.0
9.1
2.5
1.1
100.0
RACOG/AMWAC Survey (n=501)

% respondents
35.6
24.2
18.6
9.8
RACOG members (n=954)

% of members
34.9
27.3
17.0
9.0
AIHW 1995 Survey (n=974)

%respondents
34.4
26.5
16.9
9.3
Source: AIHW, RACOG and RACOG/AMWAC survey
Table B2 indicates that the geographic distribution of respondents to the

RACOG/AMWAC Survey is consistent with the distribution of the workforce as defined
by the AIHW 1995 Survey.
Table B2: Geographic distribution of RACOG/AMWAC survey respondents compared to AIHW
survey, 1997
Major urban centre
Rural area
No response
Aust
14.6
4.4
100.0
16.2
100.0
RACOG/AMWAC Survey (n=501)

% respondents
81.0
AIHW 1995 Survey (n=896)
% workforce
83.8
Source: AIHW and RACOG/AMWAC Survey
93
AMWAC 1998.6
Table B3 indicates the RACOG specialists and sub-specialists that responded to the
questionnaire.
Table B3: Response rate of specialists/sub-specialists, by gender, 1997
Qualifications
Male
Obstetrics and gynaecology
Female
Total
RACOG members
389
64
453
854
Maternal -fetal medicine
2*
1*
Uro-gynaecology
3*
1*
13
12*
2*
14
26
25
17
18
29
432
69
501
954
Obstetrical and gynaecological ultrasound

Gynaecology oncology
Reproductive endocrinology and infertility
Total
*not available for confidentiality reasons
Source: RACOG/AMWAC survey
Age Profile
From the RACOG/AMWAC Survey, the age range of respondents was from 33 years to
76 years with an average age of 50.5 years. The largest group of respondents was the
45 to 54 year age group (40.24%), followed by the 35 to 44 year age group (27.3%);
29% of respondents were aged 55 years and over (Table B4). Compared to the AIHW
Survey, obstetricians and gynaecologists in the 65 years and over age group are under
reported in the RACOG/AMWAC survey.
Table B4: Age profile of RACOG/AMWAC survey compared to AIHW survey, 1997
<35 yrs
35-44 yrs
45-54 yrs
55-64 yrs
65-74 yrs
75+yrs
24.4
3.4
1.2
26.1
8.4
2.1
RACOG/AMWAC survey (n=501)

% respondents
3.5
27.3
40.2
AIHW (n=974)
% respondents
1.5
26.3
35.6
Source: AIHW and RACOG/AMWAC survey
Gender Profile
13.8% of respondents to the RACOG/AMWAC survey were female obstetricians and
gynaecologists compared with the data from RACOG of 13.4%.
Overall, the Working Party concluded that a response rate of 53% was reasonable and
that the profile of respondents was sufficiently consistent with the profile of the
94
AMWAC 1998.6
workforce to provide representative data.

Qualifications
As indicated in Table B5, the majority of survey respondents obtained their Fellowship of
the RACOG between 1971 and 1990.
B5: Year of RACOG qualifications obstetrics and gynaecologists, 1997 (n=501)
Year
Number
<1960
13
2.8
1961-1970
88
17.6
1971-1980
140
27.9
1981-1990
137
27.3
1991-1997
91
18.2
32
6.4
No response
Year of sub-specialty qualifications are outlined in Table B6.

Table B6: Year of RACOG qualifications obstetrics and gynaecologists, 1997 (n=501)
Year
Number
1961-1970
0.2
1971-1980
12
2.4
1981-1990
18
3.6
1991-1997
31
6.2
439
87.7
No response
Hours Worked
The RACOG/AMWAC survey asked respondents to indicate the hours worked in a
typical week. The definitions used were:
Total hours worked in a typical week
The total hours spent in patient care, including hours on call back worked and time
spent on non patient care activities such as administration, continuing medical
education, teaching and research. Hours worked excluded time spent on travel between
work locations (except travel to calls out) and unpaid professional and/or voluntary
activities.
Total hours on call back worked in a typical week
Once called to duty, the time spent on duty, including travel time.
Total hours on call not worked in a typical week
The average hours per week for which the practitioner was on standby for a call to duty
95
AMWAC 1998.6
but were not worked. Once called to duty, the time spent on duty including travel time is
counted in total hours worked and should have been indicated in the total hours on call
back worked in a typical week.
On average, respondents worked a total of 62.6 hours per week (mode 60 hours;
median 60 hours; standard deviation 31.6). 22.4% of respondents worked less than 45
hours per week and 55.1% worked 55 hours or more.
A significant difference was observed between the total hours worked by males and
females, with 36% of women working less than 45 hours per week compared with 23%
of men and 53% of women working 55 hours or more per week compared with 70.8% of
men.
Table B7 details the average hours provided by obstetrics and gynaecology
specialists/sub-specialists by State and Territory. The number of The average hours
worked per week was 62.0, 42.6 hours per week were worked in direct patient care and
an additional 19.4 hours on average per week were worked on call.
It is estimated that specialists/sub-specialists worked a total of 2,747,138 hours in 1997;
of these hours 1,869,458 hours were in direct patient care. This equates to 37,654
hours per 100,000 female population (>15 years) in total hours worked, with the
provision of hours worked per 100,000 population significantly above the average in
Victoria and South Australia because of its higher local and regional catchment
population and higher workforce provision, and below the average with 27,521 in
Western Australia. This compares with the RACOG data shown in Table 1 on
obstetricians and gynaecologists population ratio per 100,000 where Victoria and South
Australia have higher specialists/sub-specialists per 100,000 and Western Australia
which has one of the lower number of specialists/sub-specialists per 100,000 ratio.
The average amount of time spent on direct patient care was 42.6 hours per week
(range 1-90 hours; median 42.0; mode 40; standard deviation 15.8).
80.8% of respondents indicated they worked on-call hours out of work hours. The
average time worked on-call out of hours was 19.4 hours per week (median 8.0; mode
10.0; standard deviation 34.8).
96
AMWAC 1998.6
Table B7: Specialists and sub-specialists in obstetrics and gynaecology average hours worked per
week and annual labour supply hours, by State/Territory, 1998
State/Terr.
NSW
Vic
Qld
SA
WA
Tas
ACT
NT
Total
Total hours worked

Ave. hours per
week
58.7
70.8
66.2
64.7
49.5
52.2
48.9
57.0
62.6
Annual hours
a
worked >000)
855.9
846.8
493.3
255.9
188.9
52.2
35.9
18.4
2,747.1
34,470
45,885
37,715
42,701
27,521
29,314
29,524
29,319
37,654
Hours worked per

100,000 female
pop.

Ave. hours per
week
41.9
43.2
44.7
42.1
41.3
35.8
36.4
52.0
42.6
Annual hours
a
worked (>000)
610.9
516.7
333.1
166.5
157.7
37.9
26.8
16.7
1,869.5
24,604
27,998
25,467
27,786
22,962
20,104
21,977
26,748
25,624
Hours worked per

100,000 female
pop.

Ave. hours
per week
Annual hours
a
worked (>000)
Hours worked per
100,000 female
pop.
17.6
21.1
21.7
24.7
13.0
18.2
6.6
26.7
19.4
256.0
252.3
161.7
97.7
49.6
19.3
4.8
8.6
851.3
10,335
13,674
12,363
16,301
7,228
10,221
3,984
13,734
11,669

Ave. hours per
week
63.0
61.3
64.3
66.8
58.9
82.2
45.6
84.0
63.1
Annual hours
a
worked (>000)
918.7
733.1
479.2
264.3
224.9
86.9
33.6
27.1
2,769.1
Hours worked per

100,000 female
pop.
36,995
39,728
36,633
44,087
32,747
46,161
27,532
43,208
37,955
Female pop. > 15

years (>000)
2,483.2
1,845.4
1,308.0
599.4
686.7
188.4
121.9
62.6
7,296.6
317
260
162
86
83
23
16
954
Specialists
Source: RACOG and RACOG/AMWAC survey
97
AMWAC 1998.6
Table B8 details the average hours provided by specialists/sub-specialists in obstetrics

and gynaecology by sex and age. In 1997 specialists/sub-specialists worked on average
62.6 hours per week, 64.0 for males and 54.0 for females. For both males and females,
those under 55 years of age averaged around 62.5 hours per week; this declined to
54.1 hours for 55 to 64 years age group, 45.8 hours for 65 to 74 years age group and
10.0 hours for those aged 75 years or more. The highest average hours worked per
week were 71.2 hours by males aged 45 to 54 years and for females 60.7 hours per
week in the 35 to 44 age range.
Table B8: Specialists and sub-specialists in obstetrics and gynaecology average hours and annual
hours worked, by gender and age group, 1998
Sex
25-34
yrs
35-44
yrs
45-54
yrs
55-64
yrs
65-74
yrs
75 yrs & over
Total
Total hours worked

Male
51.9
70.5
71.2
54.9
47.1
10.0
64.0
Female
48.7
60.7
44.8
30.0
10.0
0.0
54.0
Total
51.0
67.1
69.4
54.1
45.8
10.0
62.0
70.4
762.4
1,209.9
652.0
69.5
1.4
2,733.9

Male
37.9
45.4
47.7
38.2
31.0
10.0
43.1
Female
40.5
40.8
35.1
33.5
nr
0.0
39.0
Total
38.4
43.8
46.7
38.0
31.0
10.0
42.6
52.9
497.6
814.2
457.9
47.1
1.4
1,869.5

Male
67.9
59.7
67.1
63.6
51.5
0.0
63.7
Female
50.0
54.1
59.7
102.7
0.0
0.0
58.6
Total
65.9
57.9
66.6
64.8
51.5
0.0
63.1
90.9
657.6
1,161.1
780.9
78.2
0.0
2,769.1

Male
Female
Total
a

Specialists
13.3
21.6
18.7
15.8
26.7
0.0
18.6
5.0
2.5
25.4
1.5
0.0
0.0
21.9
12.3
21.9
19.1
15.6
26.7
0.0
19.4
16.9
248.8
332.9
188.0
40.5
0.0
851.4
30
247
379
262
33
954
Source: RACOG and RACOG/AMWAC survey
98
AMWAC 1998.6
Expected Age of Retirement

99.2% (497) of respondents provided details of their retirement intentions. The average
expected age of retirement from the workforce was 63 years (range 50 to 80 years;
standard deviation 4.6). Table B9 indicates that 22.7% of survey respondents intend
retiring in the next five years.
Table B9: Actual year of intended retirement in obstetrics and gynaecology, by State/Territory,
1997
Year
NSW
Vic
Qld
SA
WA
Tas
NT
ACT
Aust
% Aust
to 2002
24
25
18
12
11
21
113
22.7
2003-4
24
20
14
66
13.3
2005-7
27
16
22
84
16.9
2008-9
25
5.0
2010-11
28
19
14
78
15.7
2012-14
15
10
46
9.3
2015-17
14
12
10
48
9.7
2018-21
11
11
31
6.2
2022-26
1.2
152
121
91
49
44
12
25
497
100.0
Total
Type of Practice
Table B10 indicates the different practice groups of the respondents and Table B9 the
percentage of appointments in the public or private sector.
Table B10: Obstetrics and gynaecology specialists practice profiles, 1997 (n=501)
Solo and group practices
% of respondents
solo specialist
67.1
with other obstetricians and gynaecologist
20.8
No response to type of practice
8.1
multi-disciplinary group
3.2
solo and with other specialists not in obstetrics and gynaecology
0.8
99
AMWAC 1998.6
Table B11: Appointments (percentage) in the public or private sector, 1997 (n=501)
Type of practice
%
respondents
in private practice and/or undertake public hospital work
63.7
salaried in a public hospital
15.8
in private practice with no public hospital role
14.2
public hospital salaried and private practice
2.2
salaried in private hospital & in private practice &/or undertake public hospital role
0.6
university appointment with public hospital role
0.5
No response
3.0
The university appointment response rate (0.5%) is low allowing for the number of
teaching units in Australia and may be explained by respondents classifying themselves
as salaried in a public hospital role.
There were 480 respondents who indicated appointment by State/Territory as shown in
Table B12. The proportion reporting employment in public hospitals was much higher in
New South Wales (32.9%) and lower (1.3%) in Tasmania, Northern Territory and the
Australian Capital Territory. Private practice employment was highest in the New South
Wales (20.0%) and lowest in the Northern Territory (1.4%).
There were 45 sub-specialists respondents who indicated their appointment by
State/Territory. The proportion reporting employment in public hospitals was much
higher in New South Wales (46.7%) and lower (6.7%) in the Australian Capital Territory
and with no representation in Western Australia, Tasmania and the Northern Territory
(Table B13).
100
AMWAC 1998.6
Table B12: Obstetrics and gynaecology specialists appointments in the public or private sector
a
(%), by State/Territory, 1997
Main job (% of total)
NSW
Vic
Qld
SA
WA
Tas
ACT
NT
Total
salaried in a public hospital
32.9
14.5
27.6
15.8
5.3
1.3
1.3
1.3
100.0
in private practice and/or

undertake public hospital
work
33.6
29.2
13.2
8.8
11.0
2.5
1.3
0.3
100.0
in private practice with no

public hospital role
20.0
18.6
38.6
8.6
7.1
2.9
2.9
1.4
100.0
public hospital salaried and

private practice
45.5
36.4
0.0
18.1
0.0
0.0
0.0
0.0
100.0
salaried in private hospital

& in private practice &/or
role
50.0
0.0
0.0
0.0
0.0
50.0
0.0
0.0
100.0
university appointment with

0.0
33.3
33.3
33.3
0.0
0.0
0.0
0.0
100.0
31.9
25.2
19.0
10.2
9.2
2.5
1.5
0.6
100.0
Total
Notes: a - n=480 for respondents who indicated main job and State/Territory
Table B13: Practice profiles of sub-specialists in obstetrics and gynaecology (%), by

State/Territory, 1997(n=45)
Main job (% of total)
NSW
Vic
Qld
SA
WA
Tas
ACT
NT
Total
Salaried in a public hospital
46.7
20.0
13.3
13.3
0.0
0.0
6.7
0.0
100.0
in private practice and/or

work
35.0
30.0
5.0
10.0
15.0
5.0
0.0
0.0
100.0
In private practice with

12.5
50.0
12.5
0.0
12.5
12.5
0.0
0.0
100.0
public hospital salaried and

private practice
50.0
50.0
0.0
0.0
0.0
0.0
0.0
0.0
100.0
Sub-specialists
33.3
29.2
10.4
10.4
8.3
4.2
2.1
0.0
100.0
Sub-specialists
Source: AMWAC/RACOG survey
101
AMWAC 1998.6

Table B14 shows that the average waiting time for a standard first consultation with a
specialist in obstetrics and gynaecology in his/her private rooms is 16.9 days (standard
deviation 18.0) while public patients wait, on average, 31.9 days (standard deviation
48.4). The waiting time in the Australian Capital Territory for a standard first consultation
is well above the average for private patients. Tasmania exceeds that national average
waiting time (31.9 days) for public patients with a waiting period of 141.5 days for public
patients and may be contributed to an undersupply of specialists.These waiting times
are not benchmarks but are self reported.
Table B14: Obstetrics and gynaecology average waiting time (days) for a standard first
consultation and an urgent procedure, by private rooms/public outpatients department and
State/Territory 1997
State/Territory
Standard consultation
Urgent condition
Private patients
NSW
16.0
2.4
Victoria
19.1
1.9
Queensland
17.2
2.3
South Australia
12.7
1.1
Western Australia
15.4
1.7
Tasmania
15.9
1.0
Northern Territory
10.5
2.5
ACT
40.8
2.7
Total
16.9
2.0
NSW
21.9
4.5
Victoria
23.4
5.4
Queensland
37.6
14.0
South Australia
32.1
5.7
Western Australia
47.8
7.7
141.5
5.8
Northern Territory
38.5
14.0
ACT
16.3
5.3
Total
31.9
7.1
Public patients
Tasmania
102
AMWAC 1998.6
For an urgent condition, private patients wait less time (2.0 days, standard deviation 4.1)
than do patients in public outpatient departments (7.1 days, standard deviation 18.5)
(p<0.01) with public patients in Queensland and Northern Territory waiting above
average times for urgent conditions. Table B15 shows that the average waiting times for
a standard first consultation with sub-specialists in his/her private rooms ranging from
5.5 to 35 days while public patients wait, on average, from 9.6 to 63 days. The waiting
time in Victoria for a standard first consultation is well above the average for both private
and public patients (Table B 11). Waiting times for public patients in Western Australia
exceed the national average.
Table B15: Sub-specialists average waiting time (days) for a standard first consultation and an urgent
procedure, by private rooms/public outpatients department and State/Territory 1997 (n=48)
Gynaecological
Oncology
State/
Territory
Standard
Urgent
Maternal-fetal
medicine
Standard
Urgent
Ultrasound
Standard
Reproductive
Endocrinology
and Infertility
Uro-gynaecology
Urgent
Standard
Urgent
Standard
Urgent
Private patients
NSW
3.0
2.0
1.0
.5
24.0
2.3
49.0
4.0
Vic
14.0
2.5
7.7
0.6
29.8
4.0
Qld
4.0
4.0
1.0
4.5
1.0
7.0
1.0
WA
2.0
1.0
4.5
1.0
14.0
2.0
SA
26.3
4.0
7.0
1.0
7.0
1.0
5.0
NT
ACT
7.0
1.0
6.25
5.1
2.14
1.2
7.0
0
1.0
0
5.5
4.6
0.7
0.5
23.2
18.7
2.8
2.8
35.0
25.2
3.0
2.0
Tas
Total
(std dev)
Public patients
NSW
8.3
6.1
1.0
1.
35.0
2.0
98.0
1.0
Vic
14.0
4.5
18.8
1.8
46.7
13.3
Qld
4.0
4.0
14.0
1.0
45.0
5.0
WA
14.0
7.0
5.5
1.0
120.0
SA
35.0
4.3
28.0
7.0
7.0
1.0
NT
ACT
7.0
1.0
9.6
6.4
4.6
4.2
10.5
4.9
1.0
0
12.4
11.4
1.5
2.3
43.7
25.2
5.3
7.1
63.0
49.5
4.1
4.2
Tas
Total
(std dev)
103
AMWAC 1998.6
In general for an urgent condition, private patients wait less time (0.7 to 3.0 days) than
do patients in public outpatient departments (1.0 to 4.6 days) (p<0.01).
Plans to Change Hours Worked
55% (263) of respondents indicated that they planned to change the hours they work
with 43.1% (207) of respondents anticipating their work hours to decrease, 12.2% (60)
expecting their work hours to increase and 44.7% (214) expecting their hours to remain
the same.
Table B16 indicates the change in hours worked by State/Territory with 50% (75) of the
obstetric and gynaecology workforce from New South Wales anticipating a reduction in
hours over the next five years.
Table B16: Obstetricians and gynaecologists plans to change the hours they work by
State/Territory, 1997 (n=476)
State/Territory
Reduce work hours (%)
Increase work hours (%)
Remain the same (%)
NSW
50
10
40
Victoria
48
12
40
Queensland
38
54
South Aust.
38
16
46
West. Aust.
29
19
52
Tasmania
33
33
33
100
ACT
43
14
43
Total
43.1
12.2
44.7
North. Terr.
Significant associations were observed with those respondents indicating an anticipated

reduction in the hours over the next five years worked and (p<0.01):
- Gender - 46.4% of males indicated that they anticipate to reduce the hours worked
over the next five years compared to 20.3% of females.
- Geographic location - 43.3% (172) of the metropolitan workforce and 44.4% (32) of
rural areas will reduce the hours worked over the next five years.
Other reasons stated include: rising medical indemnity insurance - 80.7% (167);
lifestyle preferences - 93.5% (143); family considerations 86.5% (96); health
considerations - 66.7% (62); work place change - 62.8% (59); retirement - 60.0% (63).
Respondents also sited the following would decrease the hours worked over the next
five years: work is being done by midwives; the risk of burnout due to long hours and
103
AMWAC 1998.6
lack of appropriate support; oversupply of fellow obstetricians and gynaecologists; the

fall in private patients and dissatisfaction with the public health sector.
A significant association was observed between intention to increase hours worked and
an expected increase in demand for obstetrics and gynaecology services (p<0.01).
Other reasons sited by respondents that would increase the hours worked over the next
five years included: financial incentives and children beginning school.
Provider Shortages
Respondents were asked to specify any providers in short supply in their primary
practice location. Table B17 indicates that there is a need for more obstetricians and
gynaecologists in New South Wales/Australian Capital Territory, Victoria and
Queensland. Respondents from these three States/Territories also perceived a need for
more midwives, anaesthetists, paediatricians, psychiatrists and sub-specialists in
obstetrics and gynaecology and a range of other specialists. Among the other
specialties identified by respondents were neonatologists, general physicians,
psychologists, psychiatrists, dieticians, physiotherapists and genetic counsellors.
Table B17: Obstetricians and gynaecologists= estimates of provider shortages in the area of their
main job, by State/Territory 1997
State/ Territory
Obstetrician/
Gynaecologists
Subspecialist
Anaesthetists
Nurses/
midwives
Other
specialists
NSW
10
20
16
Victoria
29
12
Queensland
18
12
17
South Aust.
West. Aust.
10
Tasmania
North. Terr.
ACT
Total
30
21
79
52
53
There was a strong association observed between perceived need for more
obstetricians and gynaecologists and geographic location. 80.2% (219) metropolitan
respondents indicated the need for more obstetricians and gynaecologists compared to
17.2% (47) of rural respondents (n=273). Rural respondents indicated a need for more
midwives, anaesthetists, paediatricians, neonatologists, psychologists and psychiatrists
104
AMWAC 1998.6
Metropolitan Specialists Providing Rural Outreach Services

72 out of 501 (14.4%) metropolitan obstetricians and gynaecologists that responded to
the survey reported that they provided services to rural areas with the majority being
males 94.4% (68).
The average time spent by obstetricians and gynaecologists in rural areas was 23 hours
per month (mode 4 hours; median 12 hours; standard deviation 34.5). The
gynaecologists spending less than half a day and others up to 10 days per month.
The majority of metropolitan obstetricians and gynaecologists that indicated they
provided services to rural areas were aged between 41 and 55 years (53.4%).
Table B18 shows wide variation across States/Territories in the percentage of
respondents involved in the provision of rural outreach services. For example, 25.3% of
metropolitan based obstetricians and gynaecologists in Victoria and 23.9% in South
Australia reported providing rural outreach services while 15.5% of metropolitan
providers in New South Wales indicated they provided rural outreach services.
Table B18: Metropolitan obstetricians and gynaecologists providing rural outreach services (%), by
State/Territory, 1997 (n=72)
NSW
Vic
Qld
SA
WA
Tas
ACT
15.5
25.3
19.7
23.9
11.3
1.4
2.8
Respondents gave the main reasons for providing rural outreach services as: rural
lifestyle; rural demand for obstetrics and gynaecology services; committed to providing a
rural service; adds variety to my work; maintain skills; opportunity to expand practice;
remuneration; and, continue to work in rural areas because there is no replacement.
Respondents indicated that the catchment population required to sustain a rural
outreach obstetrics and gynaecology service ranged from 20,000 to 100,000 people.
The average catchment population was 40,000. It was also noted that an appropriate
infrastructure with necessary equipment and the availability of other specialists was
necessary (please refer to Appendix B for further information on requirements).
Respondents also indicated that ideally there should be a pool of about three specialists
available for visiting posts so that issues concerning on call, study leave and holidays
can be covered. More importantly this pool of specialists should remain the same so
communities are not faced with new individuals at each visit. Women have repeatedly
stressed the importance of receiving care during pregnancy and childbirth from the
same care giver, or from a small group of caregivers with whom they can become
familiar. Evidence from a controlled trial shows that women who had continuity of
caregivers were less likely to use pharmacological analgesia or anaesthesia during
105
AMWAC 1998.6
labour and birth, to have labour augmented with oxytocin, to have a labour length of
more than six hours. They were also more likely to feel well prepared for labour,
perceive the labour staff as caring, feel in control during labour and feel well prepared
for labour (Enkin et al, 1996).
Table B18 summarises the requirements for providing a sustainable rural outreach
obstetrics and gynaecology service, refer to Appendix B for further information on
service requirements.
Table B18: Basic requirements for providing a rural outreach obstetrics and gynaecology service
Local hospital facilities/equipment
In-patient bed, casualty

Small surgical/limited equipment
Telelink to consultants
Appropriate consulting facilities
Good hospital administration
Allied health professionals and

ancillary staff
Midwives/nursing
Physiotherapists
Dieticians
General practitioners
The interest and support of local GPs was considered

paramount by numerous respondents
Other specialist services
Anaesthetists
Paediatricians
Psychiatrists
Psychologists
Neonatologists
Other
Good transport to the area for both patients and specialist

local accommodation for patients
Metropolitan obstetrics and gynaecologists providing rural outreach services were asked
to indicate their reasons for preferring to live in a capital city or urban centre the
comments in order of frequency of comment are: children=s schooling, family
considerations; lifestyle, friends, cultural interests; convenience/availability of
professional facilities; always lived in an urban area; academic and research interests;
dislike rural isolation; financial considerations; better work in the city.
Resident Rural Obstetricians and Gynaecologists
94 respondents (18.8%) out of 501, indicated that they lived and worked outside a major
urban centre. The main reasons for living and working in a rural area were given as:
rural lifestyle; variety of work; good place to raise children; came from the country.
The average number of years that obstetricians and gynaecologists practising in a rural
106
AMWAC 1998.6
area intend remaining in the country was 12 years (minimum 1 years and maximum 40
years, mode 20 years).
The majority of rural respondents considered that a catchment population of 40,00060,000 was required to sustain two specialists in a resident rural practice. Two
specialists are required so that a viable obstetric and gynaecology service is offered to
the community and covered for 24 hours.
Respondents were asked to rank in order of priority the basic requirements for providing
a good resident rural obstetrics and gynaecology services. These were: the availability
of local hospital facilities and equipment; the availability of skilled nursing staff; the
availability of other specialists (ie., specialists other than obstetricians and
gynaecologists); the availability of sufficient similar specialists to provide 24 hour cover;
the availability of allied health/ancillary staff; attributes/skills of referring GPs and finally
the public hospital appointments. Other basic requirements included the need for
holiday/study leave cover, access to locum services and good schools for children,
spouse satisfaction with lifestyle, income parity with city specialists.
Locum Service Requirements
54 of the 94 rural obstetricians and gynaecologists indicated that if a specialty locum
scheme were established they would make use of it. The majority of those interested
indicated a requirement for 5 weeks of locum support (minimum 2 weeks, maximum 24
weeks, mode 4 weeks).
Overall, 69.9% of respondents were satisfied with their work. Aspects of their work with
which they were most satisfied were sufficient work to maintain competence, physical
working conditions, and the opportunity to use your abilities. Aspects of their work with
which they were most dissatisfied (in order of percentage of people expressing
dissatisfaction) were industrial relations between management and workers in your
health service, workload sufficient to maintain income, hours of work, and amount of
work (Table B20).
No difference was observed in overall level of satisfaction between urban practitioners
and rural practitioners. No differences were observed based on location of primary
practice and satisfaction with hours of work and amount of work. There also were no
differences observed in level of satisfaction with hours worked and age or gender or with
satisfaction with work hours and plans to reduce work hours.
107
AMWAC 1998.6
Table B20: Obstetrics and gynaecologists professional satisfaction (percentage), 1997 (n=485)
Indicator
Overall satisfaction
Satisfied
Uncommitted
Dissatisfied
No
response
69.9
14.6
11.8
3.8
Work environment
- physical working conditions
66.9
17.8
11.2
4.2
- industrial relations
39.3
28.9
26.5
5.2
- opportunity to use your abilities
75.4
11.2
10.2
3.2
- workload sufficient to maintain

competence
71.9
16.0
8.6
3.6
- hours of work
43.9
29.9
22.6
3.6
- amount of work
48.7
24.8
22.4
4.2
48.9
21.0
25.5
4.6
- availability of similar specialists
69.1
16.2
10.2
4.6
- availability of other specialists
78.2
11.6
5.8
4.4
- support from primary care

practitioners
63.7
21.6
10.2
4.6
- availability of skilled nursing staff
63.9
21.6
10.4
4.2
- availability of skilled allied health

personnel
60.7
25.0
9.0
5.4
The work itself
Workload
Level of income
- workload sufficient to maintain
income
Support from other providers in your area
Respondents indicated that rising medical insurance indemnity premiums will affect the
way they practice with 83% (403) indicating that they would either cease practising
obstetrics or retire early, 9% indicated that they would pass costs on to patients. Other
changes indicated were: work solely in public sector; increase workload to cover costs;
practice defensive medicine by providing more information to patients; change career;
and take more detailed medical records on patient.
Perceptions of the Factors Affecting Workforce Requirements
Respondents were asked to indicate whether they believed particular factors would
108
AMWAC 1998.6
increase workforce requirements, decrease workforce requirements or whether

requirements would stay the same (Table B21). Among the important issues that
respondents considered would increase included: more defensive medicine, patients
expectations and knowledge, advances in medical technology, and need for improved
geographic distribution of specialists. Factors perceived as most likely to decrease
workforce requirements were substitution of specialist services by other providers,
requirements for procedural practice, and cost containment strategies.
Table B21: Obstetrics and gynaecologists= perceptions of the factors that could affect the size of
the obstetrics and gynaecology workforce over the next ten years (%), 1997 (n=476)
Factors affecting the size of the workforce
Increase
Decrease
Stay the
same
No
response
Ageing of the population
42.7
8.0
44.1
5.2
Changing disease patterns
23.4
6.8
63.5
6.4
Lifestyle changes that improve population health
17.0
13.8
63.5
5.8
Patients expectations/knowledge
69.3
2.8
23.0
5.0
Requirements for safer procedural practice
66.1
26.9
0.8
6.2
Advances in medical technology
68.3
3.6
22.8
5.4
Multi-disciplinary team provision
45.3
6.0
41.3
7.4
More defensive medicine
73.1
1.4
20.2
5.4
Need for improved geographic distribution of

specialists
54.5
5.2
33.3
7.0
Increasing doctor specialisation
46.3
9.8
37.7
6.2
Substitution of specialist services by other

providers
16.0
31.7
43.9
8.4
Cost containment strategies
34.3
24.4
34.1
7.2
Reforms to increase efficiency
33.5
14.6
44.3
7.6
The introduction of coordinated care processes
25.7
17.2
46.5
10.6
Evidence-based medicine
33.9
6.2
49.7
10.2
Population trends
Clinical practice trends
Workforce trends
Health care system trends
109
AMWAC 1998.6
Medical Indemnity Insurance

One of the issues confronting the obstetrics and gynaecology profession is the real and
potential withdrawal of specialists from obstetrics, in part induced by the fear of being
sued and high indemnity insurance premiums. Any trend has to be seen against the
backdrop of the traditional career changes of obstetrics and gynaecology specialist
away from obstetrics as they get older, and the effect on recruitment of trainees to the
profession.
Respondents to the RACOG/AMWAC survey indicated that rising medical indemnity
insurance premiums will affect the way they practice with 83% (403) indicating that they
would either cease practising obstetrics or retire early and 9% indicating that they would
pass cost on to patients. Other comments included: to work solely in public sector;
increase workload to cover costs; practice defensive medicine by providing more
information to patients; change career; and take more detailed records on patients.
110
AMWAC 1998.6
APPENDIX C:
AIHW NATIONAL MEDICAL LABOUR FORCE SURVEY 1995
The Medical Labour Force Survey does not differentiate between specialists and subspecialists but examines the total workforce. In this report when reference is made to
the AIHW survey this data includes both specialists and sub-specialists.
Number of Practising Consultants in Obstetrics and Gynaecology
The Medical Labour Force Survey, 1995, AIHW, identified 974 obstetrics and
gynaecology specialists and sub-specialists indicating their main specialty of practice.
The AIHW defined a specialist in obstetrics and gynaecology as a clinician in active
practice who reported being a specialist with a qualification in obstetrics and
gynaecology. In 1986 there were 833 obstetricians and gynaecologists who were
identified as Medicare providers and a total of 968 in 1996, indicating a 16.2% increase
in the workforce during this period., with the number per 100,000 population increasing
slightly from 5.2 to 5.3.
The geographic distribution by State/Territory was similar. State provision ranged from
5.1 per 100,000 population in New South Wales and Queensland to 6.2 in South
Australia. The two Territories had a higher provision but this would be expected given a
younger age structure and relatively more births and more women in the child rearing
age groups.
The distribution of obstetrics and gynaecology specialists was 83.8% had their primary
practice in a major urban centre; 9.0% large rural centre; 4.3% in small rural centre,
2.3% in other rural centre and 0.6% in remote centre. The Medicare data indicate that
metropolitan areas and large rural centres are well serviced with specialist obstetrics
and gynaecology services, but rural and remote populations elsewhere have a much
lower patient and service coverage.
Gender Profile
There were 115 (11.8%) female obstetrics and gynaecology specialists. Males made up
88.2% (859) of the specialty.
Age Profile
There were 14 (1.4%) obstetrics and gynaecology specialists aged less than 35 years
(20.2% of which were females) and 21 (2.2%) males who were aged over 65 years of
age. For females the largest age range was the 35 to 44 year age group representing
60 (52.2%), followed by 22 (19.1%) in the 45 to 54 year age group. There were no
females aged 75 and over. For males the largest age range was the 45 to 54 year age
group representing 325 (37.8%), followed by 234 (27.2%) in the 55 to 64 year age
group. There were 21 (2.4%) male obstetrics and gynaecology specialists aged 75
years and over.
111
AMWAC 1998.6
The largest five year age cohort group was the 45 to 54 year age group with 347
specialists (35.6%), followed closely by the 35 to 44 years age group with 256 (26.3%)
and 254 (26.1%) in the 55 to 64 year age group.
Table C1: Age profile of obstetrics and gynaecology specialists, by State/Territory and gender,
1995, AIHW
Sex
<35 yrs
35-44 yrs
45-54 yrs
55-64 yrs
65-74 yrs
75+ yrs
Total
11
197
325
234
71
21
859
Females
60
22
20
10
115
Persons
14
256
347
254
82
21
974
Males
(Per cent)
Males
79.8
76.7
93.7
92.0
87.6
100.0
88.2
Females
20.2
23.3
6.3
8.0
12.4
0.0
11.8
Source: Medical Labour Force Survey, 1997, AIHW
The 1995 AIHW data indicated that the average age of the both the specialists and subspecialists was 51.1 years, with 103 (10.5%) aged 65 and over.
Table C2: Age profile of obstetrics and gynaecology specialists and sub/specialists, by
State/Territory and age, 1995
NSW
Vic
Qld
WA
SA
Tas
ACT
NT
Total
14
1.5
35-44
84
74
42
20
20
12
256
26.3
45-54
121
85
62
35
34
12
347
35.6
55-64
67
68
42
25
30
11
254
26.1
65-74
26
23
14
82
8.4
75 +
21
2.1
Total
309
258
165
89
91
25
26
11
974
100.0
Average age
51.2
51.4
50.0
50.5
51.2
55.2
49.0
56.8
51.1
% aged 65 yrs +
10.8
11.2
8.3
8.8
7.2
13.1
18.4
36.5
10.5
Age (years)
<35
Hours worked
AIHW data gave the total average hours per week as 55 hours (Table C3) with male
specialist/sub-specialists averaging 55.7 hours and for females 49.3 hours (Table C3).
Specialist/sub-specialists worked an average of 46.6 hours per week in the direct care
112
AMWAC 1998.6
of patients, with male specialist/sub-specialists averaging 47.3 hours and for females
41.2 hours. This varied from 68.3 hours in remote areas compared to 46.1 hours in
major urban areas.
Average Hours Worked - State/Territory
It is estimated that specialist/sub-specialists worked a total of 2,457,400 hours in 1995
(of these 2,079,000 were in direct patient care). This equates to 33,678 hours per
100,000 population, with the provision of hours worked per 100,000 population
significantly above the average for the Australian Capital Territory and below the
average for Tasmania with 10,721.
Table C3: Specialists and sub-specialists in obstetrics and gynaecology average hours provided
per week, annual labour supply hours (a) and hours worked per 100,000 female population (>15
years) in obstetrics and gynaecology, direct care patient care hours worked, hours on call not
worked, by State/Territory, 1995
State/Terr.
NSW
Vic
Qld
SA
WA
Tas
ACT
NT
Total
Total hours worked

Average
55.8
55.7
55.7
49.3
56.2
43.6
56.4
50.2
55.0
(hours >000)
792.3
660.0
423.4
202.0
235.3
50.7
67.1
26.5
2,457.4
Hrs worked
per 100,000
female pop
31,906
35,765
32,369
33,700
34,264
26,905
55,003
42,361
33,678

Average
47.7
45.1
50.5
44.0
42.4
35.4
49.8
47.7
46.6
(hours >000)
677.3
534.4
383.9
180.3
177.5
41.2
59.3
25.1
2,079.0
Hrs worked
per 100,000
female pop
27,275
28,959
29,349
30,080
25,847
21,864
48,610
40,123
28,493

Average
64.6
56.6
61.6
56.7
71.6
87.2
60.1
81.8
63.2
(hours >000)
608.0
367.5
281.8
149.7
232.6
77.6
57.2
28.7
1,803.2
Hrs worked
per 100,000
female pop
24,484
19,915
21,544
24,975
33,871
41,180
46,888
45,877
24,712
Female pop
> 15 years
(>000)
2,483.2
1,845.4
1,308.0
599.4
686.7
188.4
121.9
62.6
7,296.6
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AMWAC 1998.6
Average Hours Worked - Gender and Age

Those under 55 years of age averaged 60 hours per week; this declined to 49.5 hours
for 55 to 64 year olds, 31.7 hours for 65 to 74 year olds and 27.3 hours for those aged
75 or more (Table C4). The highest average hours worked per week were 54.0 hours by
males aged 45 to 64 years. 132 specialists/sub-specialists (13.5%) worked less than 35
hours per week and 12.3% reported working 80 hours per week or more, more than
double the proportion of other specialists.
Table C4: Specialists and sub-specialists in obstetrics and gynaecology average hours and annual
hours worked*, by sex and age, 1995
Sex.
25-34
yrs
35-44
yrs
45-54
yrs
55-64
yrs
65-74
yrs
75 yrs
& over
Total
Total hours worked

Male
57.2
63.5
61.2
50.3
32.8
27.3
55.7
Female
65.0
53.7
49.0
38.9
21.2
0.0
49.3
Total
59.1
61.2
60.5
49.5
31.7
27.3
55.0
Annual hours worked (>000)
38.7
725.0
969.0
580.2
118.2
26.2
2,457.4

Male
50.0
53.9
51.1
41.9
29.3
27.8
47.3
0.0
45.1
44.2
31.2
17.8
0.0
41.2
Total
50.0
51.8
50.7
41.0
28.2
27.8
46.6
26.5
617.7
817.2
485.1
105.7
26.9
2,079.0
Female

Male
46.0
60.7
66.0
63.3
60.7
40.0
63.6
Female
70.0
59.4
53.8
87.6
19.5
0.0
59.0
Total
52.0
60.4
65.4
64.4
57.0
40.0
63.2
15.1
468.3
728.7
493.0
91.1
7.0
1,803.2
14
256
347
254
82
21
974
Total spec/sub-spec
* Calculated as average weekly hours multiplied by persons by 46 weeks per year.

Average Hours Worked - Location

The results indicated that 63.6% reported on call hours worked. Hours on call not
worked for these averaged 64.3 hours per week. The proportion on call and the number
of hours on call rose with distance away from a metropolitan area, with remote area
114
AMWAC 1998.6
specialists/sub-specialists reporting 100% on call, an average of 75 hours per week

worked and a further average of 93.7 hours on call not worked as is shown in Table C5.
The average hours worked varied by region with the average hours in direct patient
care in major urban areas at 46.1 hours a week compared to 68.3 hours a week in
remote areas.
Table C5: Specialists in obstetrics and gynaecology: average working hours and average age, by
geographic location, 1995
Region of main job
Large
rural
Centre
Major
urban
centre
Total obstetrics and gynaecology workforce
Small
rural
centre
Other
rural
area
Remote
Total
AIHW (1997)
Total hours worked
54.8
58.4
59.0
39.9
75.0
55.0
46.1
51.5
53.2
41.5
68.3
46.9
64.3
59.1
66.1
70.5
93.0
64.3
62.0
63.9
79.3
81.3
100.0
63.6
51
50
50
58
48
51
Average age
Source: RACOG/AMWAC Survey 1997 and AIHW
Practice Profiles
In 1995, 84.7% of obstetricians and gynaecologists reported their main job or secondary
job was located in private rooms, 49.5% in an acute care public hospital, 9.7% in acute
care private hospital, and 16.1% in other settings. The proportion reporting employment
in public hospitals was much higher in the Australian Capital Territory (79.8%) and lower
(31.1%) in Western Australia. Private hospital employment was highest in the Australian
Capital Territory (19.8%), New South Wales (17.2%) and Tasmania (11.9%).
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AMWAC 1998.6
APPENDIX D:
SERVICE PROVISION AND REQUIREMENTS OF OBSTETRICS

AND GYNAECOLOGY
In compiling this report, the Working Party agreed that the Australian community should
have available an adequate number of trained obstetric and gynaecology specialists
appropriately distributed to provide the obstetrics and gynaecology services it requires.
All Australian residents must have access to a good standard of obstetric and
gynaecology services as well as sub-specialty services, irrespective of geography and
economic status. The community is therefore best served when obstetric and
gynaecology specialists and sub-specialists have high standards of qualification and
work with a high level of ongoing experience.
A RACOG specialists/sub-specialist in obstetric and gynaecology therefore should be
able to provide the following services:
deliver expert advice and treatment to maximise the safety and well-being of the
patient in a caring professional manner
appropriate management of pregnancy;
appropriate management of gynaecological diseases;
appropriate service proficiency across all female age groups;
appropriate level of information and explanation to patients;
appropriate tests and treatment to patients;
to arrange a further opinion if requested and practicable;
to offer referral to another obstetrician/gynaecologist if unable to care for any reason;
to provide appropriate professional cover for periods off duty or on leave; and
to be available within 15 minutes travelling time from the nearest serviced hospital;
this also holds for rural and remote areas.
Population Catchment
The population catchment required for a capital city/major urban area has been
identified as 1 per 20,000 total Australian population.
In rural and remote areas it is recommended area there be two specialists covering a
total Australian population catchment of 40,000-60,000. Two specialists are required so
that a viable obstetric and gynaecology service is offered to the community and covered
for 24 hours. Two specialists will be able to support emergencies, provide cover during
travelling time of colleague, and provide on call hours support, relief during holidays,
study and sick leave. In areas where there is outreach services provided to large
remote areas such as Cairns, RACOG has recommended that there should ideally be at
least four specialists which will allow appropriate cover for those specialists who are on
call and/or are visiting remote areas.
Other Specialist Services Required in Close Proximity

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AMWAC 1998.6
In capital cities/major urban areas the following specialists are considered necessary in
providing a good standard of obstetric and gynaecology service:
anaesthetists
dieticians
midwives
physiotherapists
neonatal trained nurses
genetic counselling services
paediatricians
access to community mental health
psychiatrists
neonatologists
ultrasound provided by individual with medical training
psychologists
availability of specialist physicians and specialist surgeons

for cross referral and consultation
In rural and remote areas the following specialists are considered necessary in providing
a good standard of obstetric and gynaecology service:
anaesthetists
psychiatrists
availability of specialist physicians and specialist surgeons

for cross referral and consultation
midwives
genetic counselling services
the ability to transfer to other hospital to services such as

ICU
paediatricians
visiting specialists such as urologists
radiology
pathology
general practitioners and surgeons with training in

obstetrics
psychologists
ultrasound provided by individual with medical training
Surgical Facilities
Surgical facilities that are required to provide obstetrics and gynaecology services
include: gynaecological equipment; sterilisation equipment. Colposcopy; ultrasound;
office hysteroscopes need to be provided wherever the outreach specialist is consulting.
Infrastructure
The following infrastructure are required in capital cities /major urban areas to provide
obstetrics and gynaecology services: a fully equipped theatre, intensive care unit,
maternal fetal unit, ultrasound and radiology unit as well as appropriate medical and
surgical backup.
In rural and remote areas a level 2 nursery is necessary. Access to the following are
also required: ante-natal care services, intensive care unit, maternal fetal unit,
ultrasound and radiology unit, telelink to consultants and access to medical and surgical
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AMWAC 1998.6
backup.
The provision of accommodation for both obstetrics and gynaecology patients is also
important as well as access to good transport to and from hospital for both patients and
specialists.
Requirements for the Indigenous Community
The most important requirement in providing appropriate services to Indigenous
communities is the education of doctors and staff in birthing facilities in appropriate
attitudes and ethnic understanding. It is also essential that there is an increase in the
number of Indigenous people working in the areas of women=s health care, nursing,
midwifery and medicine.
The provision of accommodation for both obstetrics and gynaecology patients and the
extended family is considered necessary when dealing with the Indigenous communities
and their culture. By the same token it is vital that services be provided by the same
specialist rather than new specialists so that trust and communication is established with
Indigenous patients.
Basic Requirements for Providing a Rural Outreach Service
In a rural outreach service it is important that there is an appropriate consulting facility
with a dedicated nurse or health worker who monitors the practice and sets up
appointment times and provides ante-natal care.
There is also a need for the availability of appropriate hospital infrastructures for
operative procedures; small surgical/limited equipment; access to allied health
professionals and ancillary staff; access to other specialist services; and a telelink to
other consultants. The interest and support of local GPs is also paramount in the
success of maintaining a rural outreach service. Another incentive is the availability of
good transport to the area for specialists.
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AMWAC 1998.6
APPENDIX E:
RACOG OBSTETRICS
PROGRAM
AND
GYNAECOLOGY
TRAINING
The following information on the obstetrics and gynaecology training program was
provided by RACOG
Eligibility
Prospective trainees must hold medical registration approved by a relevant certifying
authority.
All trainees commencing the RACOG Training Program will be required to complete the
requirements of the new FRACOG Training Program which includes a four year
Integrated Training Program and a two year Elective Training Program.
The Integrated Program consists of defined clinical and educational experience in
training hospitals. This includes the MRACOG Distance Education Program and intraining assessment in the form of the In-Hospital Clinical Assessment modules. The
terminal or exit assessment for the Integrated Program will be the MRACOG
examination, which is designed to test core knowledge and skill. This examination will
continue to consist of the MRACOG written (MCQ) examination and the MRACOG oral
(OSCE) examination. Because it will be the terminal assessment for the Integrated
Program, trainees are only able to attempt the MRACOG examination for the first time
during Year 4 of the (the final year) of the Integrated Program.
The Elective Program is completed in the remaining two years of the MRACOG/
FRACOG Training Program. This program is designed to offer Trainees an opportunity
to pursue a special interest in a planned way. Trainees are required to submit a plan for
a two-year program which is designed to meet their own educational needs. This plan
must be prospectively approved. Some obvious options include further training in
operative obstetrics and gynaecology, training in provincial posts, research leading to a
postgraduate degree (eg. MD or MPH) and the commencement of sub-specialty
training.
The requirements for being granted the FRACOG will be satisfactory completion of both
the Integrated Program (including passing the MRACOG examination) and the Elective
Program.
Integrated Program Essentials
The following are Essentials for an Integrated Program. In other words, for a program to
be accredited by the College, it must be able to offer the following:
a planned rotation over a four year period which includes at least 12 months
experience in hospitals other than the home hospital and at least 12 months in a
tertiary hospital;
a Program Coordinator with responsibility for coordinating that Integrated Program
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AMWAC 1998.6
a tutorial program specifically designed for MRACOG trainees; and

levels of clinical experience such that each Trainee can obtain the following
minimum levels of experience over the four years of the program.
Figures for procedures refer to the number of procedures available to be performed, not
assisted, by the Trainee. All figures refer to the minimum levels of experience which
hospitals must agree to arrange for each Trainee over the four year period of the
Integrated Program. However, they do not define absolute requirements that must be
met by each Trainee.
100 normal deliveries (supervision and management)
100 Caesarean sections
100 operative vaginal deliveries (including multiple pregnancy, ventouse, breeches,
forceps)
100 major abdominal surgical procedures
50 major vaginal surgical procedures
200 laparoscopic examinations or procedures
100 hysteroscopic examinations or procedures
100 colposcopic examinations
50 hours of ultrasound
300 hours in gynaecology clinics (inc. specialist clinics in uro-gynaecology and
reproductive medicine)
300 hours in obstetrics clinics
3 months in an approved gynaecologic oncology unit (at least 50% of this time must
be spent in clinical work in gynaecologic oncology)
In addition to these essentials, each Integrated Program is required to meet the
standards already in place for approval of training posts as defined in the document
Standards for the Accreditation of MRACOG/FRACOG Training Posts. However, it is
not necessary for each of the training posts in the Integrated Program rotation to meet
all of these standards (e.g. library requirements) as accreditation is based on the four
year program rather than on any individual training post.
All trainees who entered the Training Program after 1 January 1997 are required to
spend at least six months in a provincial post at some stage of the MRACOG/FRACOG
Training Program (i.e. as a component of either an Integrated Program or an Elective
Program). Trainees are advised by the Program Coordinator/Training Supervisor of
their planned rotation for the four year program, at the commencement of Year 1.
Approval for training at a provincial training post will be based on the particular merits of
that training post. Flexibility regarding the model for training supervision will be
considered.
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AMWAC 1998.6
Program Coordinators
Each Integrated Program is coordinated by a Program Coordinator, appointed by the
College for a minimum two year period. The Program Coordinator is responsible for
planning the local Integrated Program and coordinating the progress of Trainees
through the program. As such, the Program Coordinators role is similar to the Chairman
of a State Training and Accreditation Committee in those states which already offer a
statewide program or similar to the Senior Training Supervisor in major teaching
hospitals which already offer a program involving rotation to other hospitals. The role of
the Training Supervisor in the individual hospitals will continue with little change.
Hospital-Based and State-Based Integrated Programs
Because each Integrated Program is four years in duration and because it must involve
at least two hospitals, each program must be offered cooperatively by at least two
hospitals. This is, however, the only institutional requirement. An Integrated Program
could thus be offered by:
a tertiary hospital and a single peripheral hospital;
a tertiary hospital and a number of peripheral hospitals;
two or more tertiary hospitals;
all of the teaching hospitals within an Australian state;
two or more hospitals, at least one of which is a tertiary hospital, in different
Australian states;
two or more hospitals, at least one of which is a tertiary hospital, in different
countries
A program which included all of the teaching hospitals within a state (a state-based
program) might, in effect, have no base hospital but instead be coordinated from the
State Training and Accreditation Committee. However, it is expected that most
programs are hospital-based in the sense that Trainees receive most of their training at
a single base or home hospital and rotate out to other hospitals intermittently.
Elective Programs
While Integrated Programs are designed to standardise the clinical and educational
experience available to Trainees in the core areas of obstetrics and gynaecology,
Elective Programs may be individualised to meet the needs and interests of the Trainee.
Each trainee is required to submit a learning plan for prospective approval by the State
Training and Accreditation Committee. The Trainees Elective Program may focus on:
extending expertise in general obstetrics and gynaecology; extending expertise in
gynaecological surgery; developing expertise in provincial practice; developing research
expertise; developing expertise in an area of special interest; commencing sub-specialty
training or developing expertise in practice in the third world.
The Elective Program is designed to be individualised and its aims will therefore vary
from trainee to trainee. However, there are some aims which should be common to
most Elective Programs, especially those pursued in the last two years of training.
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AMWAC 1998.6
These include the development of confidence and competence in surgery; confidence

and competence in patient management; career directions; leadership skills; teaching
skills; financial management skills; and people management skills.
While there is no intention to make any of these mandatory, it is expected that most
individualised Elective Programs will focus on at least some of these areas.
Resources Required for the Training of Specialists in Obstetrics and Gynaecology
Whether a program receives accreditation is determined by the nature and content of
the program in regard to its adequacy in: clinical exposure and >in-service= training;
teaching sessions and seminars; instruction in pathology; instruction in medicine and
surgery relevant to obstetrics and gynaecology; and library facilities which include
obstetrics and gynaecology textbooks listed in the College recommended reading list,
together with an adequate selection of general medical texts and journals as well as Email and Internet access.
There also needs to be time for reading and study during normal working hours and
arrangements to allow trainees to attend lectures and seminars within the hospital itself
and at other institutions.
For accreditation a program should have the following content:
clinical obstetrics and gynaecology, it is expected that the majority of training will be
spent in clinical work with the trainee responsible, under supervision, for the care of
patients in both the outpatients department and the wards;
pathology;
medicine and surgery relevant to obstetrics and gynaecology.
library with E-mail and Internet access and general reading (journals, preparation for
seminars and case presentations);
regular teaching sessions/seminars and group discussions.
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AMWAC 1998.6
APPENDIX F: GENERAL PRACTITIONERS PROVIDING OBSTETRICS AND

GYNAECOLOGY SERVICES
One of the features of the obstetrics and gynaecology workforce is the scope for
alternative providers to provide some of the services. The pattern of health care
provision in obstetrics and gynaecology varies markedly by region, with specialist
involvement much more likely in the capital cities and much less likely in regional areas.
In rural and remote areas, GP and midwifery provision is predominant. These patterns
have clear implications for specialist requirements and the need for provision of
services.
GENERAL PRACTITIONERS
RACOG Diploma and Certificate Programs in Women=s Health
Generally, GPs wishing to provide obstetrics and gynaecology services complete an
additional training program in obstetrics and gynaecology. The training is overseen by
the Joint Consultative Committee - RACOG and RACGP. GPs can qualify with either the
Diploma of RACOG (DRACOG) and the Certificate of Satisfactory Completion of
Training in Womens Reproductive Health (CSCT).
The aim of the DRACOG is to provide training to GP obstetricians who wish to be able
to:
perform normal deliveries, assisted deliveries and to a limited extent, breech
deliveries;
perform basic gynaecological procedures;
undertake shared ante and postnatal care with specialists obstetricians or a
specialist hospital;
manage of the antenatal care of low to moderate risk to patients; and,
provide family planning advice
The DRACOG is a time limited qualification and requires re-certification every three
years.
The aim of the CSCT is to provide training to GP obstetricians who wish to provide:
shared ante and postnatal care with specialists obstetricians, GP obstetrician or a
specialist hospital;
management of the antenatal care of low to moderate risk to patients;
office gynaecology; and,
family planning.
CSCT holders do not undergo re-certification, instead they are asked to declare their
commitment to maintenance of standards by involvement in the RACGP quality
assurance and continuing medical education program.
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AMWAC 1998.6
The duration of training for the DRACOG is for a minimum period of six months and the
CSCT is for a minimum period of three months.
Currently there are 2,845 GPs who have the (DRACOG). Table F1 shows that Victoria
has the highest number (35.1%) of qualified GPs in obstetrics and gynaecology. There
are a further 161 DRACOG candidates who at the end of 1997 have applied to sit the
written and oral examinations.
Table F1: General practitioners qualified to practice in obstetrics and gynaecology and general
practitioners candidates for the DRACOG, by gender and State/Territory 1997
Gender
NSW
Vic
Qld
WA
SA
Tas
ACT
NT
Total
Qualified DRACOG
Males
447
548
223
186
189
35
21
31
1,680
Females
263
451
123
101
135
31
25
36
1,165
Total
710
999
346
287
324
66
46
67
2,845
25.0
35.1
12.2
10.1
11.4
2.3
1.6
2.3
100.0
DRACOG candidates
Males
21
28
17
10
91
Females
19
25
70
Total
40
53
23
18
15
161
Source: RACOG 1997
There are currently 27 GPs who have the CSCT qualification in Australia. There are a
further 93 CSCT candidates who at the end of 1997 have applied to sit the written and
oral examinations.
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AMWAC 1998.6
Table F2: General practitioners qualified with the Certificate Satisfactory Completion of Training in
womens health and candidates, by gender and State/Territory 1997
Gender
NSW
Vic
Qld
WA
SA
Tas
ACT
NT
Total
Qualified CSCT
Males
Females
20
Total
11
27
CSCT candidates
Males
12
29
Females
12
29
12
64
Total
18
41
15
93
Source: RACOG 1997
Rural and Remote General Practitioners who Practice in Obstetrics and

Gynaecology
The Centre for Rural Health conducted a National Rural General Practitioner Survey in
1996. The survey collected information in regards to rural general practitioners working
in obstetrics and gynaecology and this information is shown below in Table F3. Of the
survey respondents, 541 indicated that they practice in obstetrics and gynaecology. All
of these respondents were qualified in either DRACOG or CSCT.
Table F3: Rural and remote general practitioners who practice in obstetrics and gynaecology, by
NSW/ACT
Vic
Qld
WA
SA
Tas
NT
Total
GPs practising in
obstetrics & gynaecology
138
123
96
105
61
10
541
25.5
22.7
17.7
19.4
11.3
1.9
1.5
100.0
Source: Centre for Rural Health, 1997
Female GPs represented 15.5% of the GPs who indicated they practice in obstetrics
and gynaecology.
Age Profile
50% of respondents who indicated that they were GPs who practice in obstetrics and
gynaecology were aged 35 to 44 years, and 41.2% were aged over 45 years.
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AMWAC 1998.6
Table F4: Age profile of rural and remote general practitioners who practice in obstetrics and
gynaecology, by sex and age, 1997
Age (years)
Males
Females
Total
less than 35
30
18
48
8.9
35-44
220
50
270
50.0
45-54
138
17
155
28.7
55-64
45
49
9.1
65-74
16
17
3.1
6.1
Total
451
90
541
100.0
83.4
16.6
100.0
100.0
75+
Geographic Location
The majority of respondents providing obstetrics and gynaecology services were located
in other rural areas (28.5% of the total female population) (59.9%); 15.2% of
respondents were located in remote areas. Table F5 below shows the age and
geographic distribution of GPs who practice in obstetrics and gynaecology in rural and
remote areas of Australia. The highest age range is in the 36 to 40 year olds at 26.4%
with the majority of this age group (62.9%) working in other rural areas. The highest
proportion (30.9%) in remote areas are represented by the 41 to 45 year olds.
Table F5: Age profile of rural and remote general practitioners who practice in obstetrics and
gynaecology by geographic location, 1997
Age (years)
Small rural area
Other rural area
Remote centre
Remote other
31-35
12
36
36-40
33
90
12
41-45
36
79
12
13
46-50
25
55
51-55
15
19
56-60
17
61-65
66-70
10
Total
133
320
39
42
24.9
59.9
7.3
7.9
<31
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AMWAC 1998.6
Hours Worked
The average hours worked by GPs who are practising in obstetrics and gynaecology in
rural/remote areas of Australia is 1.06 hours (std. deviation 0.1) in obstetrics. Those
aged 35 to 44 years of age indicated the highest average hours per week at 1.36 hours.
Current Issues Regarding the Decline in GP Obstetricians
Comprehensive national data is not available on the number of services provided by GP
obstetricians and therefore the trend in service provision. This is a serious data
deficiency when attempting to determine which practitioners are providing obstetrics and
gynaecology services.
Nevertheless, it is generally considered that there is a decline in the number of GPs
providing birthing services. For example, the number of GPs who performed more than
five private patient confinements (including Caesareans) annually declined by 37.2% in
the period from 1988 to 1992 (AIHW). This does not give the complete picture as it is
likely that GPs continue to provide at least the non-procedural components of birthing
services quite extensively.
Anecdotal evidence suggests that the likelihood that birthing services to public patients
in public hospitals are provided by GPs more often in rural and remote areas and less
often in provincial/urban areas. However, with the general decline in numbers of rural
and remote birthing practitioners and the availability of local birthing services this may
have an adverse effect upon patient safety. For example, women in rural areas prefer to
give birth close to home which can lead them to choose to stay at home until it becomes
too late to go anywhere except the local hospital. This can be because of personal
preference, but more often, it can be because of financial necessity or the need for
close family support. This is particularly the case for Aboriginal and Torres Strait
Islander women. Alternatively, where a woman has a short labour, the same result can
occur as an automatic consequence of labour. The delay in attending hospital, the
possible lack of facilities and expert back-up close at hand, and the consequent
emergency nature of the birth can compromise the safety of the birthing services.
As the number of GPs providing procedural birthing services declines, the effect on the
availability of local birthing services in rural and remote areas is likely to be more
adverse because the majority of services in these areas have traditionally been provided
by GPs rather than specialists.
Various studies have been undertaken to examine the reasons GP obstetricians are
discontinuing practice and these are summarised below.
Lifestyle and Family Considerations
A study of why GPs are ceasing obstetrics in Victoria was conducted by Dr Kathy Innes
in 1996. The findings of this study confirm the hypothesis that reasons other than those
related to Medical indemnity insurance premium increases and fear of litigation are
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AMWAC 1998.6
important in a GPs decision to cease intrapartum obstetric practice. The study found
that the other reasons are primarily to do with lifestyle and family. Medicolegal threat
was chosen by a significant number of doctors as a secondary reason for ceasing
obstetrics.
The qualitative information gained from this study indicates that ceasing to provide
obstetric care is a difficult decision for many family physicians and that a socially
acceptable reason related to cost benefit or fear of litigation is easier to justify to oneself
and ones community than the real reason which may be related to home and family.
This is particularly true in small to medium size communities where loss of even one
service provider is crucial and the family doctor is more likely to be held responsible for
the loss of such a service.
Analysis of the GPs most important reason for ceasing obstetrics shows that 36% (18)
chose personal, family or interference with lifestyle as their number one reason for
ceasing. 16% (8) chose rising insurance premiums. Concern regarding the management
of unexpected emergencies and lack of remuneration were chosen by 10% (5) and 8%
(4) respectively. Other reasons for ceasing obstetrics included: closure of local hospital;
not doing enough deliveries to maintain skills and the stress of being constantly on call
and the exhaustion of working night and day.
Comparison between the reasons from rural GPs and urban or provincial GPs
suggested that both groups consider personal, family and lifestyle issues as the most
important 29% versus 40%. Urban/provincial GPs, however site lack of remuneration
(12%) and interference with other clinical responsibilities (8%) as important. Rural GPs
indicated that rising insurance premiums (25%) and concern regarding the management
of unexpected emergencies (13%) were also very important to them.
In an analysis of the doctors suggestions to keep GPs practising obstetrics, 45% (24)
of the GP respondent doctors felt that the most useful suggestion for retaining doctors in
obstetrics involved increasing the fees. Comments were made that it takes 10 deliveries
just to pay the medical defence premiums. Suggestions included: altering the on-call or
after hours arrangements 19% (10) and altering the medical defence arrangements 11%
(6).
Medical Indemnity
Another indicator for the decline in the number of GPs providing obstetric services is the
increasing cost of medical indemnity. Indemnity insurance increases pose a problem for
GP obstetricians who provide services in rural and remote areas where they need
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AMWAC 1998.6
to undertake at least 20 deliveries a year under the sessional payment system to cover
the extra medical indemnity required to do obstetrics.
Specialists have been able in part to compensate the medical indemnity situation by an
increase in incomes, as their patient caseload increased as an outcome of the trend for
more women to seek specialist care irrespective of the complexity or risk to their birth.
While this move to specialist care for all births including low risk births is an option in
urban Australia, the same cannot be said for rural areas. It is difficult for specialists to
gain what is perceived as adequate remuneration in small rural centres, simply because
of the relatively small potential patient base upon which it is possible to draw and this is
where the need for rural and remote GP obstetricians emerges.
Studies have been undertaken to show that the medical insurance situation is a key
reason for the declining numbers of GPs practising in obstetrics.
One such study by Watts et al in 1997, found that South Australian GPs are leaving
obstetrics at an alarming rate and that the most important reason for ceasing obstetrics
was indemnity insurance (56.8%) followed by lifestyle issues (54.5%) and poor
remuneration (34.1%), litigation fear (29.5%), declining deliveries (29.5%) and wanning
skills (22.7%).
The study also reported that the recent rise in obstetric (procedural) indemnity insurance
has made rural obstetric practice financially nonviable and threatened the whole service.
Most GPs felt that a full subsidy tied to accreditation, but not to the number of activities,
is the best way to solve the crisis. GPs also favoured independent legal tribunals as a
method to handle malpractice claims.
Similarly a New South Wales survey conducted by Dr Mark Henschke in 1997 found
that the continuation of GP obstetrics in major rural hospitals (sessional payment) is
unlikely unless there is medical insurance intervention to assist GP obstetricians in small
rural centres.
The survey obtained a 90% (80) response rate and found that almost one in four had
stopped providing obstetric services in the previous two years. 54% indicated that they
were planning to stop in the next two years, and 17% indicated that they would be
continuing with GP obstetrics beyond 1999.
Of those GP obstetricians who had stopped in the previous three years, 70% cited the
cost of medical indemnity insurance as the major factor and a further 20% indicated the
stress associated with the obstetrics and the pressure of constantly being on call. When
asked what would entice them back to GP obstetrics, 60% indicated that financial
support, such as an Obstetrics Incentive Allowance, would make them reconsider their
decision to abandon obstetrics. Other recommendations that would help were specialist
support and a roster for Medicare patients.
129
AMWAC 1998.6
Other Reasons Why Rural Doctors Leave Their Communities

General social, cultural and professional issues are acknowledged all of which are well
documented. A summary of these reasons is presented below.
Access to health care in much of rural Australia remains poor by urban standards. There
are many rural and remote communities that have traditionally had difficulty in attracting
and keeping doctors. While the interest in a rural career among medical students and
recent graduates appears to be increasing, there is little evidence that recruitment and
retention of rural doctors is dramatically improving.
Studies have also been undertaken to examine why rural doctors leave their
communities. One such study undertaken by Hays et al in 1997 examined rural and
remote Queensland doctors during 1995 and found there were are series of issues such
as: family, education and support, cultural deprivation, limited social amenities, lack of
privacy, limited education and employment opportunities for family members and
financial considerations that are raised.
The study found that the initial sense of responsibility to the rural communities,
enjoyment of the clinical variety, autonomy and family lifestyle, and appreciation of
assimilation into the community were powerful influences to stay. However, enthusiasm
waned in response to pressures to return to a larger centre. Overwork, awareness that
family and friends were distant and appreciation of the educational and career
limitations of staying too long contributed incrementally to a situation where there was
no longer any perceived reason to stay.
Another very basic factor such as the identification with the community also brought
disadvantages. Rural medical families have little, if any, anonymity, contributing to the
feeling that it is difficult not to be at work. The close and special relationship with the
community can interfere with clinical work. Being an important part of a close community
also tests other relationships. Personality clashes can develop with significant
community leaders, such as senior nursing staff, other doctors, health managers and
local government leaders. Small communities are difficult to live in when there are
uncomfortable relationships with powerful but unavoidable individuals.
In response to questions about measures that could entice a longer commitment the
following suggestions were offered: improving housing quality; quality and access to
locums for longer holidays, particularly for longer services; short term CME relief; the
provision of more flexible delivery CME through the use of information technology; the
provision of management training to be offered during vocational training; the
development of educational packages for families, such that children are being
supported locally.
The study found that many urban background doctors will not stay more than three to
five years in certain smaller communities. In the longer term, increased selection of
130
AMWAC 1998.6
students from a rural background should provide a higher proportion of graduates who
will remain comfortable with rural community life.
In Australia, and particularly rural Australia, where obstetric services are largely
dependent upon GPs as service providers, access to obstetric care is threatened if the
issues mentioned above are not addressed. Once a doctor has ceased obstetrics, the
evidence would suggest that they do not resume and will not consider resuming except
under the most urgent of clinical circumstances.
131
AMWAC 1998.6
APPENDIX G:
AMWAC SURVEY OF DIVISIONS OF GENERAL PRACTICE
METHODOLOGY
To obtain information about the adequacy of the supply of specialist obstetric and
gynaecology services throughout Australia, AMWAC administered a mailed survey of all
Divisions of General Practice. Of a possible 122 Divisions, 77 responded (63.1%).
RESULTS
Distribution of Respondents
Table G1 shows the distribution of responding Divisions to the AMWAC survey by
State/Territory and by location. 37.6% of Divisions were from New South Wales, 26%
from Victoria, 11.7% from Queensland, 10.4% from Western Australia and 7.8% from
South Australia. With respect to location, 35.1% were located in a capital city, 13% in an
other metropolitan area and 51.9% in a rural area.
Table G1: Distribution of responding Divisions of General Practice, by State/Territory and
% DGP* by location
Total
number
of DGP*
% DGP*
by
State/Terr.
Capital City
Other
metropolitan
Rural
Total
NSW
29
37.6
24.1
27.6
48.3
100.0
Victoria
20
26.0
40.0
0.0
60.0
100.0
Qld
11.7
33.3
22.2
44.4
100.0
South Aust.
7.8
16.6
0.0
83.3
100.0
West. Aust.
10.4
62.5
0.0
37.5
100.0
Tasmania
2.6
50.0
0.0
50.0
100.0
North. Terr.
2.6
50.0
0.0
50.0
100.0
ACT
1.3
100.0
0.0
0.0
100.0
77
100.0
35.1
13.0
51.9
100.0
State/Terr.
Australia
*Number of Divisions of General Practice

Source: AMWAC survey of Divisions of General Practice
When the data from (Table G1) are compared with the distribution of all Divisions of
General Practice (Table G2) it can be seen that among respondents to the AMWAC
survey, New South Wales Divisions are over-represented, Queensland Divisions are
under-represented and rural Divisions are over-represented.
132
AMWAC 1998.6
Table G2: Distribution of all Divisions of General Practice in Australia, by State/Territory and
% DGP* by location
Total
number
of DGP*
% DGP* by
State/Terr.
Capital city
Other
metropolitan
Rural
Total
NSW/ACT
36
29.5
44.4
27.7
27.7
100.0
Victoria
32
26.2
53.1
12.5
34.4
100.0
Qld
20
16.4
40.0
35.0
25.0
100.0
South Aust.
14
11.5
35.7
7.1
57.1
100.0
West. Aust.
13
10.7
69.2
0.0
30.8
100.0
Tasmania
2.5
33.3
33.3
33.3
100.0
North. Terr.
3.4
25.0
0.0
75.0
100.0
122
100.0
46.7
18.9
34.4
100.0
State/Terr.
Australia
*Number of Divisions of General Practice

Triggers for General Practitioner Referral to a Specialist Obstetrician

Gynaecologist
Divisions of General Practice were asked to indicate the importance of eight triggers
for referral to an obstetrician and gynaecologist and to identify any further important
triggers. Table G3 indicates that the two most important triggers for a referral are
condition unresponsive to treatment and severity of the condition followed by lack of
experience within the practice regarding the condition and/or its treatment, the
availability of appropriate back-up, rarity of the diagnosis and request of patient to be
referred. The least important triggers for referral to an obstetrician and gynaecologist
were the age and social circumstances of the patient. No differences were observed
among responses to this question based on location (ie., metropolitan or rural).
133
AMWAC 1998.6
Table G3: Importance of eight triggers for general practitioner referral to an obstetrician and
gynaecologist, 1997
Trigger
Not important
Very important
Condition unresponsive to treatment
0.0
1.8
12.5
41.1
44.6
Severity of the condition
0.1
1.2
15.6
57.1
26.0
Lack of experience
0.0
8.8
24.6
43.9
22.8
Availability of appropriate back-up
0.0
10.7
23.2
37.5
28.6
Rarity of the diagnosis
5.4
12.5
17.9
37.5
26.8
Request of patient to be referred
5.3
10.5
24.6
43.9
15.8
Age of patient
22.8
28.1
28.1
15.8
5.3
Social circumstances of the patient
36.8
33.3
19.6
10.5
0.0
Supply of Resident and Visiting Obstetricians and Gynaecologists

Table G4 indicates that 22.2% (n=14) of Divisions of General Practice reported that
there were no resident obstetrics and gynaecology specialists providing services in the
area covered by their Division. Of these Divisions, 7 (50%) were from New South
Wales, and all but one were from rural locations. Further analysis revealed that of the
Divisions with no resident obstetrics and gynaecology specialists all but two had
specialists visiting their area.
Table G4: Percentage of Divisions with resident obstetricians and gynaecologists providing
services in area, by State/Territory, 1997
Number of resident obstetricians and gynaecologists
State/
Terr.
None
One
Two
Three
Four
Five-Ten
11 or
more
Total
NSW
28.0
20.0
4.0
20.0
8.0
8.0
12.0
100.0
Vic
15.4
7.7
15.4
46.2
0.0
15.4
0.0
100.0
Qld
28.6
0.0
0.0
14.3
14.3
42.9
0.0
100.0
SA
33.3
50.0
16.6
0.0
0.0
0.0
0.0
100.0
WA
12.5
37.5
0.0
12.5
0.0
25.0
12.5
100.0
Tas
0.0
0.0
0.0
0.0
50.0
50.0
0.0
100.0
NT
0.0
0.0
100.0
0.0
0.0
0.0
0.0
100.0
22.2
19.0
7.9
20.6
6.3
17.5
6.3
100.0
Aust
134
AMWAC 1998.6
Adequacy of the Supply of Obstetricians and Gynaecologists

55.4% (n=43) of Divisions of General Practice considered that a shortage of obstetrics
and gynaecology specialists existed in their area with the remaining predominantly of
the opinion that supply was about right (Table G5). One Division in South Australia
considered there was an oversupply. States/Territories with the greatest shortage of
obstetrics and gynaecology specialists were New South Wales, Victoria and the
Northern Territory. Significantly (p<0.05), a greater percentage of rural Divisions
(61.5%) perceived the supply of obstetrics and gynaecology specialists to be inadequate
than did Divisions located in capital cities (50%) or other urban areas (50%).
Comments on the adequacy of services reflected the distribution of obstetrics and
gynaecology specialists. For example, Divisions in well supplied areas commented that
access is good, a specialist is always available and we have excellent access through
the flying O&G service in Queensland. Divisions in poorly supplied areas commented
that access is excellent in the town but poor in remote areas. Aboriginal women have to
travel to town for ultrasounds, waiting time for specialists is three months, waiting times
for public patients is too long, adequacy during weekends and nights is poor. Impending
shortages were also commented on. For example Divisions indicated that some GPs
are giving up obstetric practice because of the costs of indemnity insurance and that in
some cases this is placing a heavy burden on other GPs.
Suggestions for improving the supply of obstetrics and gynaecology services included
training more specialists, specialists doing more visits to regional centres, allowing GPs
and midwives to do antenatal care, opening the rural hospital, improved transport,
training for small hospital GP antenatal services to Aboriginal women, shared care and
improved financial incentives for GP confinements in rural areas with phone link with
specialists.
Table G5: Adequacy of the supply of specialist obstetricians and gynaecologists by State/Territory,
1997
State/Terr.
Shortage
About Right
Over supplied
Total
NSW
70.0
30.0
0.0
100.0
Victoria
66.7
33.3
0.0
100.0
Queensland
42.9
57.1
0.0
100.0
South Aust.
0.0
83.3
16.7
100.0
West. Aust.
42.9
57.1
0.0
100.0
Tasmania
50.0
50.0
0.0
100.0
100.0
0.0
0.0
100.0
55.4
42.9
1.7
100.0
NT
Australia
135
AMWAC 1998.6
Requirement for Additional Resident and Visiting Obstetricians and

Gynaecologists
In response to the question If a shortage for obstetrics and gynaecology specialists
exists in your area, please indicate the number of resident and visiting specialists
required, Divisions with shortages indicated a need for 82 resident specialists and 26
visiting specialists. Resident specialists are required in New South Wales (26), Victoria
(22), Queensland (6), Western Australia (5), the Northern Territory (9) and Tasmania
(4). Capital city located Divisions perceived a requirement for 44 resident obstetrics and
gynaecology specialists while rural Divisions required 31 and other metropolitan
Divisions required 7. Visiting specialists are required in Victoria (13), New South Wales
(8), Queensland (3), Western Australia (1) and the Northern Territory (1). Capital city
located Divisions perceived a requirement for 17 visiting specialists and rural Divisions
required nine.
Availability of General Practitioners with Qualifications in Obstetrics and
Gynaecology
Over 72.7% (n=56) of Divisions responded to the question about the number of resident
general practitioners providing services in their area with qualifications in obstetrics and
gynaecology. Of these, all but three Divisions indicated that there was one or more
resident general practitioner providing services in their area with qualifications in
obstetrics and gynaecology.
Significantly, over 80% of rural Divisions indicated that they had one or more resident
qualified general practitioners in their area while the comparative figures for other
metropolitan areas and capital city areas were 70% and 48.1% respectively (Table G6).
Only five Divisions reported having general practitioners visiting their area with
qualifications in obstetrics and gynaecology and all were located in capital cities.
Table G6: Number of Divisions with resident general practitioners with qualifications in obstetrics
and gynaecology providing services in area, by State/Territory, 1997
Number of resident GPs with qualifications in obstetrics and gynaecology
Location
of DGP*
None
One
Two
Three
Four
Five-Ten
11 or
more
Total
Capital City
15
Other
Urban
Rural
11
13
34
Total
14
23
56
* DGP - Divisions of General Practice

Satisfaction with the Diploma of Obstetrics offered by RACOG

136
AMWAC 1998.6
Divisions indicated strong support for the Diploma of Obstetrics offered by the Royal
Australian College of Obstetrics and Gynaecology. Ninety three percent of Divisions
answered in the affirmative to the question Do you consider the Diploma of Obstetrics
offered by RACOG the preferred qualification by general practitioners in Australia?
Comments as to how the program could be improved included a need to develop more
hands-on skills to equip rural GPs and the need for a definite rural component.
Summary
The findings arising from this survey of Divisions of General Practice indicate an overall
shortage of obstetrics and gynaecology specialists. However, this shortage is greater in
some State/Territories than others and is particularly pronounced in some rural and
remote areas. Divisions of General Practice have indicated a need for an additional 82
resident obstetrics and gynaecology specialists and 26 visiting specialists.
There is strong support among Divisions for the RACOG Diploma of Obstetrics and at
least 43% of Divisions of General Practice throughout Australia have general
practitioners with qualifications in obstetrics and gynaecology providing services to
patients in their area.
137
AMWAC 1998.6
APPENDIX H:
DATA ON MIDWIVES
Definition
A midwife is a person who, having been regularly admitted to a midwifery educational
program, duly recognised in the country in which it is located, has successfully
completed the prescribed course of studies in midwifery and has acquired the requisite
qualifications to be registered and/or legally licensed to practice midwifery.
She must be able to give the necessary supervision, care and advice to women during
pregnancy labour and the postpartum period, to conduct deliveries on her own
responsibility and to care for the newborn and the infant. This care includes preventative
measures, the detection of abnormal conditions in mother and child, the procurement of
medical assistance and the execution of emergency measures in the absence of
medical help. She has an important task in health counselling and education, not only
for the women, but also within the family and the community. The work should involve
antenatal education and preparation for parenthood and extends to certain areas of
gynaecology, family planning and child care. She may practice in hospitals, clinics,
health units, domiciliary conditions or in any other service.
(Jointly developed by the International Confederation of Midwives and the International Federation of
Gynaecology and Obstetrics. Adopted by the International Confederation of Midwives Council 1972.
Adopted by the International Federation of Gynaecology and Obstetrics 1973. Later adopted by the World
Health Organization. Amended by the International Confederation of Midwives Council, Kobe October
1990. Amendment ratified by the International Federation of Gynaecology and Obstetrics 1991 and the
World Health Organisation 1992.)
Main Characteristics of the Midwifery Workforce

Number of Nurses Employed as Clinicians in Midwifery, Obstetrics and Gynaecology
The AIHW Nursing Labour Force Survey indicated that, in 1995, there were 13,913
registered and enrolled nurses employed in midwifery and 1,540 employed in obstetrics
and gynaecology. Table H1 below shows that New South Wales has 31.1% of midwives
where the Northern Territory has 1.4% of the total workforce.
Table H1: Registered and enrolled nurses in midwifery, obstetrics and gynaecology, by
Type of nurse
clinician
NSW
Vic
Qld
WA
SA
Tas
ACT
NT
Total
Midwifery
4,325
3,803
2,323
1,152
1,366
399
344
201
13,913
505
351
284
212
109
39
32
1,540
4,830
4,154
2,607
1,364
1,475
438
376
209
15,453
% midwives
31.3
26.9
16.9
8.8
9.5
2.8
2.4
1.4
100.0
% female population
34.0
25.3
17.9
9.4
8.2
2.6
1.7
0.9
100.0
Obstetrics and
gynaecology
Total
Source: Nursing Labour Force, AIHW 1997 and ABS
138
AMWAC 1998.6
In 1995, there were 195,692 nurses, nurses in midwifery and obstetrics and
gynaecology represented 7.9% of the nursing workforce. In 1993 there were 13,759
registered and enrolled nurses in midwifery, obstetrics and gynaecology, a 12.3%
increase in the period 1993 to 1995.
In 1995 there were 85.6 registered nurses per 100,000 population in midwifery,
obstetrics. This consisted of 82.2 registered nurses per 100,000 population and 3.4
enrolled nurses per 100,000 population.
Gender Profile
In 1995, 99.0% of the midwifery workforce were females.
Age Distribution
Table H2 shows the age distribution of midwives in Australia in 1995 and indicates that
the majority of midwives are aged 35 to 39 years (25.0%) and that 65.5% of midwives
are aged over 35 years. 69.2% of nurses employed as clinicians in obstetrics and
gynaecology are aged over 35 years.
Table H2: Nurses employed as clinicians in midwifery and obstetrics and gynaecology, by age
group, 1995
Age (years)
Midwives
% Midwives
Obstetrics &
gynaecology
% Obstetrics &
gynaecology
Less than 25
133
1.0
58
3.8
25-29
1,494
1.7
145
9.4
30-34
3,176
22.8
271
17.6
35-39
3,482
25.0
293
19.0
40-44
2,547
18.3
294
19.1
45-49
1,569
11.3
229
14.9
50-54
898
6.5
151
9.8
55-59
463
3.3
76
4.9
60-64
132
0.9
19
1.2
18
0.1
0.3
13,913
100.0
1,540
100.0
65 and over
Total
Source: Nursing Labour Force, AIHW 1997
139
AMWAC 1998.6
Geographic Location
The geographic location of nurses employed as clinicians in midwifery, obstetrics and
gynaecology in 1995 indicated that the majority (74.1%) were based in capital
cities/metropolitan centres, 23.9% were located in rural areas and 1.9% were in remote
areas (Table H3).
Table H3: Nurses employed as clinicians in midwifery and obstetrics and
gynaecology, by geographic location, 1995
Geographic location
Capital city
66.2
Other metropolitan centre
7.9
large rural centre
11.3
Small rural centre
6.9
Other rural area
5.7
Remote centre
1.2
Other remote area
0.9
Hours Worked
The average hours worked by nurses employed as clinicians in midwifery, obstetrics
and gynaecology in 1995 was 32.3 hours. Those working part time (<35 hours)
represented 53.0% and those working full time (35 hours+) was 47.0%.
Work Setting
Table H4 shows that 76.2% of nurses employed as clinicians in midwifery, obstetrics
and gynaecology worked in the public sector and 23.8% worked in the private sector.
Table H4: Nurses employed as clinicians in midwifery and obstetrics and gynaecology, by work
setting of main job, 1995
Work setting
Hospital
Community
Agency
Other
Total
Public
72.3
0.8
0.9
2.2
76.2
Private
21.0
1.0*
0.6
1.3
23.8
* Medical (doctors rooms)
Current Supply of Midwives

Each State/Territory health department was requested to provide recent data on nurses
employed as clinicians in midwifery and information on known shortages or oversupply
of midwives. There was an overall difficulty experienced by all State/Territories in
140
AMWAC 1998.6
providing baseline data on midwifery staff. It was not possible for Victoria, Queensland
and South Australia to provide a response. Of those States/Territories that were able to
provide information, all indicated there was an undersupply of midwives.
New South Wales
The Nurses Registration Board of New South Wales indicated that as of 30 December
1997, there were approximately 10,400 qualified nurses in midwifery/mothercraft of
which 3,044 were currently working in midwifery. This leaves a potential pool of recruits
of over 7,000 recruits.
Of the 3,044 currently working midwives the largest age group is the 35 to 39 year olds
at 26.2%. 63.7% of practising midwives were located in capital city/metropolitan areas,
20.7% were located in provincial city/rural areas and 0.2% were located in remote
areas, 15.4% gave no response.
A 1996 report conducted by the New South Wales Health Department, Workforce
Planning Study for Maternity Service Nurses, Adult Critical & Intensive Care and
Operating Room Nurses estimated that there is a shortage of maternity service nurses
in New South Wales. This conclusion was based on an examination of various trends
including demographic, utilisation patterns of hospital maternity services and trends in
service delivery patterns in maternity services. It also found that;
there has been a trend towards greater numbers of mothers planning to give birth in
a birthing centre from 723 in 1990 to 3,404 in 1994;
there are significant differences between rural and metropolitan maternity services
with the segmentation of midwifery practice into large maternity units and a general
under utilisation of midwifery skills in smaller hospitals, particularly in rural hospitals;
and,
there is a need to enhance parenting education services and maternity services for
women with special needs.
The report recommended that to address the gap between requirements of midwives
and supply of services there is a need to:
increase the number of nurses in the maternity services workforce;
reduce the current wastage rate;
maintain the current midwifery student numbers (320 per year); and
ensure full employment of midwifery students.
Western Australia
The Labour Force Survey Western Australia 1997 report which contributes to the AIHW
National Labour Force collections indicated that there were 2,814 registered midwives,
2350 actually working and 931 working in midwifery. Midwives represented 16% of the
nursing population.
141
AMWAC 1998.6
In Western Australia, the average age of midwife respondents have risen every year for
which records are available, from 37.8 years in 1989 to 42.7 years in 1997.
A greater proportion of midwives than would be expected of the total nursing population
reported that their main job was in rural Western Australia (32% compared to 27%
nationally) and fewer midwife respondents worked in the private sector for their main job
than was observed for nurses as a whole (27% compared to 30% nationally).
Total entrants to the nursing workforce are also decreasing, so it could be expected that
fewer nurses will be available to go into midwifery in the future. Western Australias
projected needs for midwives based on the 1995 Nurse Workforce Planning Project are
for 70 new midwives produced in Western Australia to join the workforce per year.
Currently, Western Australia does not reach this figure as many students switch from full
time to part time, and others do midwifery so they can go on to child health.
In December 1996, for example, there were 26 metropolitan and 40 rural midwifery
vacancies. The number of agency staff used to temporarily cover midwifery positions
was 369 in the metropolitan area and 20 in the rural area, all at considerable expense,
and sometimes for considerable durations. 23% of surveyed sites predicted midwifery
shortages during 1997 (Nursing Vacancies Survey Report Western Australia: June to
December 1996).
Western Australia indicated that there is an ongoing shortage of skilled midwives
available to practice in rural and remote areas. Some towns had ceased obstetric
services because midwives could not be provided.
A pilot Rural Midwifery Course between King Edward Memorial Hospital and the rural
Health Service Units is underway, with the first cohort of four students commencing the
course in October 1997 with a second group of six expected to commence in March
1998. The students are required to give a commitment to return to a rural area as a
midwife on completion of the course.
South Australia
A report produced for the South Australian Health Commission on the South Australian
Midwifery Training Requirements 1997-2002 indicated that between May 1994 to
September 1996 South Australian midwifery requirements declined from 1,288.4 to
1,112.7 FTEs. However, midwifery requirements are unlikely to decline further,
particularly as the birth rate in South Australia is likely to remain steady at a little below
20,000 over the period 1997-2001. It was suggested that at least 109 midwives should
be trained each year.
Training numbers in South Australia have been historically low, for example, about 60
midwives in total were trained in the three years up to and including 1996. These low
training numbers already appear to have had significant impact on the age profile of the
142
AMWAC 1998.6
midwifery workforce. The current age distribution shows less than 7% of working
midwives are under the age of 30 years, while 45% are aged between 35 and 45 years.
The current age distribution, which indicates 53% of the midwife workforce is aged over
40, lends considerable weight to the argument that training numbers should
considerably exceed the levels of the past three years if the midwifery workforce size
remains anywhere near its current level.
The recommendations by the report were: that universities be notified of the future
requirements; midwifery training numbers should be at least 109 per annum over the
period 1997 to 2001; and a review be done in 1998-99.
Tasmania
Tasmania has 1,863 licensed midwives. 50.7% (942) of midwives are aged over 45
years.
A 1996 survey by the Nursing Board of Tasmania found that 31.4% (604) of
respondents practised midwifery or used their skills in a practice setting which is not
exclusively midwifery (ie. family child health nurse, family planning nurse). Those
working directly in midwifery totalled 357 (18.5%). Of nurses working directly in
midwifery 165 worked in the Southern Region, 116 in the Northern Region and 76
worked the Northwest Region.
The survey also found that 554 (47.8%) of licensed midwives had not utilised their skills
for in excess of five years. With the implementation of the Board=s new Competence to
Practice Policy on 1 July 1998, it is hypothesised that the number of licensed midwives
will drop by anywhere between 50% and 70%, giving approximate numbers of licensed
midwives from 1 September 1998 to between 930 and 560.
The number of graduates in midwifery during 1992 to 1997 was 158 graduates. With
hospital based training in Tasmania ceased in 1997 the future training of midwives has
raised concerns for the future midwifery workforce. It has been estimated that Tasmania
will require at least 20 midwife graduates per year. Arrangements have begun to be
formulated with Flinders University in South Australia to provide the necessary training
to those students who wish to take up midwifery and practice in Tasmania.
Northern Territory
Table H5 represents the actual and establishment requirement for midwives in the
Northern Territory and indicates there is a definite shortage of community midwives in
the Northern Territory.
A major problem with attracting and maintaining midwives in the Northern Territory is
the professional and personal isolation experienced by the midwives. Another factor
that may contribute to the high turnover rates is that a majority of midwives are from
interstate and are working their way across Australia.
143
AMWAC 1998.6
The Northern Territory Health Services also holds a 14 day cultural experience rotation
for community nurses which tries to address cultural issues that are relevant to the large
Aboriginal population in the Northern Territory.
Table H5: Midwives in the Northern Territory, by type of employment category (FTE), December
1997
Area of employment
Actual (FTE)
Requirement(FTE)
Public hospital - Darwin
44
44
Public hospital - rural and remote
77
74
Community urban
15
Community remote
15
48
Flight nurses (with double certificate)
15
15
Specialised women=s health service
Educators
Source: Northern Territory Health Services
Issues
Anecdotally, midwives are reluctant to participate in the workforce in a midwifery
capacity for several reasons, including legal and ethical issues, remuneration,
recognition of qualifications, opportunities to apply and maintain specialist skills, the
impact of the staffing arrangements offered in terms of compatibility with family
responsibilities and financial security offered by limited shift patterns.
The modes of health care delivery also have not encouraged team work and mutual
recognition of skills between medical and midwifery staff, with an atmosphere of
demarcation existing in some instances. It is anticipated that a move toward models in
which continuity of care and a team approach is used may improve this situation, as well
as the overall quality of care for the patient.
While the figures show that a only a low percentage of those registered as midwives are
actually practising in midwifery, there are a number of related nursing fields in which a
midwifery qualification is of great utility, such as neo-natal intensive care, child health,
and community nursing, as well as geographic factors which, while precluding the formal
practice of midwifery in small and remote locations, continues to render the possession
of midwifery qualifications desirable in at least one staff member, in case of emergency.
Midwifery qualifications and registration may also have been a valuable part of
achieving a management or administrative position, but return to midwifery practice is
unlikely.
144
AMWAC 1998.6
Analysis is yet to be undertaken to determine to what level these factors would raise the
proportion of midwifery registrants who use their midwifery qualifications or perceive
them to be necessary to their current employment. In short, the proportion of midwifery
registrants who are actively employed in midwifery does not comprehensively depict the
application of midwifery skills in Australia, nor does it mean that those midwives not
currently employed in midwifery are or would be available to move into that field.
There is also a range of education issues that are currently under discussion which are
outside the concerns of this review but may affect the future midwifery workforce. This
includes:
The transfer of midwifery education to the higher education sector has been
accepted as a positive way forward by the midwifery profession in Australia and the
need for universities to be more flexible with practice based courses as well as the
need for close collaboration between service providers and universities to achieve
success of midwifery education programs.
Midwifery is currently considered under legislation as a specialty of nursing in all
States, however, there is currently a debate as to whether potential candidates for
midwifery can enroll directly into a midwifery degree without having to first undertake
a general nursing training degree and therefore not prolong the training period, and
making the midwifery qualification subject to HECS rather than a full fee paying
status. While this decision is being disputed, the current situation is considered to
pose a threat to enrollment, as does the lack of recognition for the additional skills
and qualifications gained.
Furthermore, a prospective midwifery student can choose to remain in a nursing
position and be rewarded for years of experience with no further requirement for
formal study other than professional updating. Midwifery does not result in any
special allowance despite the nature of the increased responsibility and
accountability that is expected of the practitioner.
With the move towards the evolving models of care the role of a midwife is expected
to change. This will require new skills/education, increased responsibility and
therefore increased autonomy by midwives. It is anticipated that industrial and other
implications may arise with the new roles associated with new service models.
145
AMWAC 1998.6
APPENDIX I:
AIHW NATIONAL HOSPITAL MORBIDITY DATA
Obstetrics and Gynaecology National Hospital Morbidity Data Source

Data relating to obstetrics and gynaecology procedures were extracted from the AIHW
National Hospital Morbidity Database. The National Hospital Morbidity Database is a
compilation of electronic summary records collected in public and private hospitals.
Almost all hospitals in Australia are included. The exceptions are public hospitals not
within the jurisdiction of a State or Territory health authority or the Department of
Veterans= Affairs (that is, hospitals operated by the Department of Defence, for
example, and hospitals located in off-shore Territories).
In addition, data were not able to be supplied for the one private hospital in the Northern
Territory, the private free-standing day hospital facilities in the Australian Capital
Territory, the public psychiatric hospitals in Queensland and some private Victorian
separations in 1993-94 and 1994-95. For 1995-96, a further expansion of the scope has
occurred, with morbidity data for public psychiatric hospitals included for all but
Queensland.
Definitions
Procedures
Procedures are reported according to the ICD-9-CM codes (at the 3-digit level). The
ICD-9-CM classification encompasses the National Health Data Dictionary definition
whereby a procedure is one that is surgical in nature, carries a procedural risk, carries
an anaesthetic risk, requires specialised training, or requires special facilities or
equipment only available in an acute setting. The ICD-9-CM classification also includes
non-surgical investigative and therapeutic procedures such as x-rays and
chemotherapy.
Obstetrical procedures
Obstetrical procedures are defined as in the ICD-9-CM chapter of the same name.
Gynaecological procedures
Gynaecological procedures are defined as in the ICD-9-CM chapter Operations on the
female genital organs.
Private patient
Either a patient who is eligible for Medicare who elects to be a private patient or a
patient who is not eligible for Medicare.
Public patient
A patient who is eligible for Medicare who does receives treatment free of charge ie
charges are paid through the Medicare Agreements, by the Department of Veterans
Affairs or, less commonly, by other arrangements such as compensation, Defence
Force entitlements or common law arrangements.
145
AMWAC 1998.6
Limitations of the Data

Although the National Health Data Dictionary definitions form the basis of the definitions
of the database, the actual definitions used may have varied among the data providers
and from one year to another. In addition, fine details of the scope of the data
collections may vary from one jurisdiction to another. Comparisons between years and
sectors should therefore be made with caution. Comparison between years in this
exercise has been limited by incomplete reporting of the private or public status of
patients in 1993-94 and 1994-95.
146
AMWAC 1998.6
Table I1: Gynaecological procedures (ICD-9-CM groupings) undertaken on public and private
patients (a), Australia, 199596
Unknown
Procedure
650 Oophorotomy
651 Diagnostic procedures on ovaries
Public
Private
patient
patient
patient
status
Total
589
306
895
429
536
965
652 Local excision or destruction of ovarian lesion or tissue
4,054
4,740
8,796
653 Unilateral oophorectomy
1,378
1,176
2,554
654 Unilateral salpingo-oophorectomy
2,522
2,384
4,907
507
500
1,007
4,915
4,857
9,773
655 Bilateral oophorectomy

656 Bilateral salpingo-oophorectomy
657 Repair of ovary
181
110
291
658 Lysis of adhesions of ovary and fallopian tube
2,285
2,546
4,832
659 Other operations on ovary
3,322
14,142
17,464
660 Salpingotomy and salpingostomy
1,095
574
1,669
77
437
514
12,691
7,289
19,980
661 Diagnostic procedures on fallopian tubes

662 Bilateral endoscopic destruction or occlusion of fallopian tubes
663 Other bilateral destruction or occlusion of fallopian tubes
3,384
1,728
5,112
664 Total unilateral salpingectomy
470
431
901
665 Total bilateral salpingectomy
446
303
749
666 Other salpingectomy
2,118
1,214
3,334
667 Repair of fallopian tube
1,008
672
1,680
668 Insufflation of fallopian tube
5,002
7,289
12,291
509
5,331
5,840
669 Other operations on fallopian tubes

670 Dilation of cervical canal
554
731
1,285
671 Diagnostic procedures on cervix
6,558
3,836
10,395
672 Conization of cervix
2,850
1,830
4,680
673 Other excision or destruction of lesion or tissue of cervix
17,767
15,267
33,039
674 Amputation of cervix
159
178
337
675 Repair of internal cervical os
431
437
868
676 Other repair of cervix
204
104
308
47
18
65
29,723
37,024
12
66,759
4,741
7,310
12,053
249
185
434
684 Total abdominal hysterectomy
9,935
9,433
19,371
685 Vaginal hysterectomy
7,076
7,494
14,572
307
309
616
17
13
30
680 Hysterotomy
681 Diagnostic procedures on uterus and supporting structures
682 Excision or destruction of lesion or tissue of uterus
683 Subtotal abdominal hysterectomy
686 Radical abdominal hysterectomy

687 Radical vaginal hysterectomy
688 Pelvic evisceration
689 Other and unspecified hysterectomy
690 Dilation and curettage of uterus
691 Excision or destruction of lesion or tissue of uterus and supporting structures
692 Repair of uterus supporting structures
693 Paracervical uterine denervation
694 Uterine repair
695 Aspiration curettage of uterus
696 Menstrual extraction or regulation
697 Insertion of intrauterine contraceptive device
42
26
68
248
257
505
70,465
61,121
19
131,605
1,883
2,366
4,249
708
594
1,303
59
169
228
63
44
107
25,895
26,530
52,431
1,108
842
1,951
699 Other operations on uterus, cervix, and supporting structures
588
4,369
4,957
700 Culdocentesis
248
524
772
701 Incision of vagina and cul-de-sac
970
10,876
11,846
147
AMWAC 1998.6
702 Diagnostic procedures on vagina and cul-de-sac

703 Local excision or destruction of vagina and cul-de-sac
704 Obliteration and total excision of vagina
705 Repair of cystocele and rectocele
706 Vaginal construction and reconstruction
11,149
6,105
17,257
2,263
2,950
5,213
40
45
85
8,300
9,062
17,362
15
63
78
1,897
2,142
4,039
708 Obliteration of vaginal vault
134
145
279
709 Other operations on vagina and cul-de-sac
798
1,023
1,822
710 Incision of vulva and perineum
710
589
1,299
711 Diagnostic procedures on vulva
815
605
1,420
712 Operations on Bartholin's gland
1,796
1,235
3,032
713 Other local excision or destruction of vulva and perineum
2,677
2,417
5,097
25
17
42
707 Other repair of vagina
714 Operations on clitoris

715 Radical vulvectomy
62
31
93
716 Other vulvectomy
120
100
220
717 Repair of vulva and perineum
495
433
928
718 Other operations on vulva

719 Other operations on female genital organs
Total
62
63
125
103
64
167
261,340
275,543
67
536,950
Source: AIHW National Hospital Morbidity Database

(a) Private and public patients have been classified according to the 'patient accommodation status' data field. This field is
defined in accordance with the National Health Data Dictionary. Private patients in this table comprise 'eligible private
patients' and 'ineligible patients', public patients comprise 'eligible public patients', 'eligible DVA patients' and 'eligible other patients'.
Table I2: Obstetrical procedures (ICD-9-CM groupings) undertaken on public and private patients(a), Australia, 199596
Unknown
Procedure
Public
Private
patient
patient
patient
status
Total
720
Low forceps operation
534
538
1,074
721
Low forceps operation with episiotomy
2,888
2,272
5,162
722
Mid forceps operation
5,920
5,729
11,649
723
High forceps operation
140
146
286
724
Forceps rotation of fetal head
1,686
1,702
3,389
725
Breech extraction
1,042
406
1,449
726
Forceps application to aftercoming head
62
30
92
727
Vacuum extraction
6,023
4,004
10,028
728
Other specified instrumental delivery
13
18
31
729
Unspecified instrumental delivery
46
31
77
730
Artificial rupture of membranes
50,146
25,413
75,564
731
Other surgical induction of labour
226
121
347
732
Internal and combined version and extraction
109
733
Failed forceps
734
76
33
477
298
775
Medical induction of labour
29,705
17,835
47,544
735
Manually assisted labour
10,814
3,884
14,699
736
Episiotomy
16,052
10,152
26,204
738
Operations on fetus to facilitate delivery
76
69
145
739
Other operations assisting delivery
353
62
415
740
Classical caesarian section
210
142
352
741
Low cervical caesarian section
27,643
19,476
47,123
742
Extraperitoneal caesarian section
743
Removal of extratubal ectopic pregnancy
51
31
82
744
Caesarian section of other specified type
11
16
749
Caesarian section of unspecified type
30
22
52
148
AMWAC 1998.6
750
Intra-amniotic injection for abortion
751
Diagnostic amniocentesis
752
Intrauterine transfusion
753
Other intrauterine operations on fetus and amnion
754
Manual removal of retained placenta
755
Repair of current obstetric laceration of uterus
756
Repair of other current obstetric laceration
757
Manual exploration of uterine cavity, postpartum
758
Obstetric tamponade of uterus or vagina
759
Other obstetric operations

Total
35
19
54
380
81
463
82
20
102
22,695
4,015
13
26,723
3,783
1,607
5,393
225
66
291
49,173
25,568
74,749
195
69
264
26
13
39
174
117
291
230,995
123,997
47
355,039

(a) Private and public patients have been classified according to the 'patient accommodation status' data field. This
field is defined in accordance with the National Health Data Dictionary. Private patients in this table comprise 'eligible
private patients' and 'ineligible patients', public patients comprise 'eligible public patients', 'eligible DVA patients' and
eligible other patients'.
Table I3: Percentages of obstetrical procedures (ICD-9-CM groupings) undertaken on public patients (a,b) in given age
categories, Australia, 199596 in given age
(per cent)
Age (years)
Procedures
014
1524
2534
3544
4554
5564
Total
720
0.0
31.5
56.2
12.2
0.2
0.0
100.0
721
0.1
33.2
57.6
9.0
0.1
0.0
100.0
722
0.1
32.0
58.5
9.4
0.1
0.0
100.0
723
0.0
31.4
60.0
8.6
0.0
0.0
100.0
724
0.1
31.7
57.8
10.1
0.3
0.0
100.0
725
Breech extraction
0.0
25.0
58.7
16.0
0.2
0.0
100.0
726
0.0
22.6
67.7
9.7
0.0
0.0
100.0
727
Vacuum extraction
0.2
32.0
58.2
9.6
0.1
0.0
100.0
728
0.0
23.1
69.2
7.7
0.0
0.0
100.0
729
0.0
32.6
56.5
10.9
0.0
0.0
100.0
730
0.1
35.8
55.0
9.1
0.0
0.0
100.0
731
0.0
37.6
52.7
9.7
0.0
0.0
100.0
732
0.0
31.6
52.6
14.5
1.3
0.0
100.0
733
Failed forceps
0.2
31.2
58.9
9.6
0.0
0.0
100.0
734
0.1
33.7
56.1
10.1
0.1
0.0
100.0
735
0.0
34.9
54.9
10.2
0.0
0.0
100.0
736
Episiotomy
0.1
34.2
56.3
9.4
0.0
0.0
100.0
738
0.0
28.9
51.3
19.7
0.0
0.0
100.0
739
0.0
24.9
61.8
13.3
0.0
0.0
100.0
740
0.5
21.0
57.6
20.5
0.5
0.0
100.0
741
0.1
24.5
60.1
15.2
0.1
0.0
100.0
742
0.0
33.3
66.7
0.0
0.0
0.0
100.0
743
0.0
29.4
52.9
17.6
0.0
0.0
100.0
744
0.0
27.3
63.6
9.1
0.0
0.0
100.0
749
0.0
16.7
70.0
13.3
0.0
0.0
100.0
750
0.0
42.9
42.9
14.3
0.0
0.0
100.0
751
0.0
17.9
44.7
36.8
0.5
0.0
100.0
752
1.2
14.6
58.5
25.6
0.0
0.0
100.0
753
0.1
37.6
52.2
10.0
0.1
0.0
100.0
754
0.1
28.4
57.4
13.9
0.1
0.0
100.0
755
0.0
30.2
48.9
20.9
0.0
0.0
100.0
149
AMWAC 1998.6
756
0.1
31.1
58.3
10.5
0.0
0.0
100.0
757
0.5
32.3
52.3
14.9
0.0
0.0
100.0
758
0.0
34.6
46.2
19.2
0.0
0.0
100.0
759
1.1
28.7
52.9
14.9
1.7
0.6
100.0
Total
0.1
32.7
56.5
10.7
0.1
0.0
100.0

(a) Private and public patients have been classified according to the 'patient accommodation status' data field. This field is defined
in accordance with the National Health Data Dictionary. Private patients in this table comprise 'eligible private patients' and
'ineligible patients', public patients comprise 'eligible public patients', 'eligible DVA patients' and 'eligible other patients'.
(b) 47 patients were of unknown accommodation status - these are included in the total tables (Tables 17 and 18) but not in this
public patient table nor in the private patient table.
150
AMWAC 1998.6
Table I4: Percentages of obstetrical procedures (ICD-9-CM groupings) undertaken on private patients (a,b) in
given age categories, Australia, 199596
(per cent)
Procedure
Age (years)
014
1524
2534
3544
4554
5564
75+
Unkn.
Total
720
0.0
7.4
72.1
20.4
0.0
0.0
0.0
0.0
100.0
721
0.0
7.7
75.7
16.5
0.0
0.0
0.0
0.0
100.0
722
0.0
8.5
75.3
16.2
0.0
0.0
0.0
0.0
100.0
723
0.0
6.8
77.4
15.8
0.0
0.0
0.0
0.0
100.0
724
0.0
7.2
75.1
17.6
0.1
0.0
0.0
0.0
100.0
725
Breech extraction
0.2
3.2
75.1
21.4
0.0
0.0
0.0
0.0
100.0
726
0.0
0.0
76.7
23.3
0.0
0.0
0.0
0.0
100.0
727
Vacuum extraction
0.0
7.5
74.6
17.9
0.1
0.0
0.0
0.0
100.0
728
0.0
5.6
77.8
16.7
0.0
0.0
0.0
0.0
100.0
729
0.0
6.5
83.9
9.7
0.0
0.0
0.0
0.0
100.0
730
0.0
8.2
74.3
17.4
0.1
0.0
0.0
0.0
100.0
731
0.0
10.7
65.3
23.1
0.0
0.8
0.0
0.0
100.0
732
3.0
3.0
60.6
33.3
0.0
0.0
0.0
0.0
100.0
733
Failed forceps
0.0
9.7
74.2
16.1
0.0
0.0
0.0
0.0
100.0
734
0.0
8.0
73.6
18.3
0.1
0.0
0.0
0.0
100.0
735
0.0
6.9
73.1
19.8
0.2
0.0
0.0
0.0
100.0
736
Episiotomy
0.0
7.5
75.5
16.9
0.0
0.0
0.0
0.0
100.0
738
1.4
37.7
37.7
21.7
1.4
0.0
0.0
0.0
100.0
739
0.0
1.6
72.6
25.8
0.0
0.0
0.0
0.0
100.0
740
0.0
4.2
59.9
35.9
0.0
0.0
0.0
0.0
100.0
741
0.0
5.3
70.1
24.4
0.2
0.0
0.0
0.0
100.0
742
0.0
0.0
100.0
0.0
0.0
0.0
0.0
0.0
100.0
743
0.0
9.7
74.2
16.1
0.0
0.0
0.0
0.0
100.0
744
Ceasarian section of other specified type
0.0
0.0
100.0
0.0
0.0
0.0
0.0
0.0
100.0
749
0.0
0.0
63.6
31.8
4.5
0.0
0.0
0.0
100.0
750
0.0
21.1
57.9
21.1
0.0
0.0
0.0
0.0
100.0
751
0.0
2.5
35.8
61.7
0.0
0.0
0.0
0.0
100.0
752
0.0
0.0
50.0
50.0
0.0
0.0
0.0
0.0
100.0
753
Other intrauterine operations on fetus and

amnion
0.0
8.2
70.2
21.5
0.1
0.0
0.0
0.0
100.0
754
0.0
4.8
70.9
24.0
0.2
0.0
0.0
0.0
100.0
755
0.0
6.1
72.7
21.2
0.0
0.0
0.0
0.0
100.0
756
0.0
6.8
74.1
19.0
0.0
0.0
0.0
0.0
100.0
757
Manual exploration
postpartum
0.0
1.4
78.3
20.3
0.0
0.0
0.0
0.0
100.0
758
0.0
30.8
53.8
15.4
0.0
0.0
0.0
0.0
100.0
759
0.0
7.7
72.6
17.1
0.9
0.9
0.9
0.0
100.0
Total
0.0
7.3
73.4
19.3
0.1
0.0
0.0
0.0
100.0
of
uterine
cavity,

(a) Private and public patients have been classified according to the 'patient accommodation status' data field. This field is defined in
accordance with the National Health Data Dictionary. Private patients in this table comprise 'eligible private patients' and 'ineligible patients',
public patients comprise 'eligible public patients', 'eligible DVA patients' and 'eligible other patients'.
(b) 47 patients were of unknown accommodation status - these are included in the total tables (Tables 17 and 18) but not in this private
patient table nor in the public patient table.
151
AMWAC 1998.6
Table I5: Percentages of gynaecological procedures (ICD-9-CM groupings) undertaken on patients (both public and
private) in given age categories, Australia, 199596
Age (years)
Procedure
014 1524 2534
3544 4554
5564
6574
75+ Unkn
.
Total
650
Oophorotomy
0.4
18.7
36.3
32.1
10.5
1.0
0.4
0.6
0.0
100.0
651
Diagnostic procedures on ovaries
1.5
15.9
31.2
26.7
15.1
4.0
3.0
2.6
0.0
100.0
652
Local excision or destruction of ovarian lesion or

tissue
1.1
19.0
38.7
27.9
9.7
1.5
1.4
0.8
0.0
100.0
653
Unilateral oophorectomy
0.6
5.0
18.8
34.7
22.4
7.6
6.1
4.9
0.0
100.0
654
Unilateral salpingo-oophorectomy
0.5
3.8
16.4
41.8
26.9
4.6
4.3
1.7
0.0
100.0
655
Bilateral oophorectomy
0.3
0.5
8.5
23.7
35.4
14.8
10.3
6.5
0.0
100.0
656
Bilateral salpingo-oophorectomy
0.1
0.2
3.7
18.1
43.1
17.1
11.7
6.0
0.0
100.0
657
Repair of ovary
2.4
17.9
39.5
33.0
5.8
0.7
0.3
0.3
0.0
100.0
658
Lysis of adhesions of ovary and fallopian tube
0.2
11.4
41.3
33.0
11.1
2.2
0.5
0.3
0.0
100.0
659
Other operations on ovary
0.3
9.4
46.4
38.5
4.5
0.5
0.3
0.1
0.0
100.0
660
Salpingotomy and salpingostomy
0.1
18.7
58.7
20.3
1.7
0.2
0.1
0.1
0.0
100.0
661
Diagnostic procedures on fallopian tubes
0.6
7.0
58.8
30.0
2.1
0.6
0.4
0.6
0.0
100.0
662
Bilateral endoscopic destruction or occlusion of

fallopian tubes
0.0
3.5
45.6
47.8
3.2
0.0
0.0
0.0
0.0
100.0
663
Other bilateral destruction or occlusion of fallopian

tubes
0.0
4.7
55.1
38.7
1.4
0.0
0.0
0.0
0.0
100.0
664
Total unilateral salpingectomy
0.3
5.8
25.7
42.6
18.9
2.9
2.9
0.9
0.0
100.0
665
Total bilateral salpingectomy
0.0
2.0
24.6
42.5
20.2
6.0
3.6
1.2
0.0
100.0
666
Other salpingectomy
0.6
16.6
48.8
26.8
5.6
1.2
0.4
0.2
0.0
100.0
667
Repair of fallopian tube
0.0
4.2
52.8
41.5
1.4
0.1
0.0
0.0
0.0
100.0
668
Insufflation of fallopian tube
0.0
13.8
59.8
25.5
0.8
0.0
0.0
0.0
0.0
100.0
669
Other operations on fallopian tubes
0.1
6.2
53.9
37.6
1.9
0.2
0.0
0.0
0.0
100.0
670
Dilation of cervical canal
0.7
17.7
31.1
26.2
13.5
5.7
3.5
1.6
0.0
100.0
671
Diagnostic procedures on cervix
0.1
21.6
30.9
22.4
13.9
5.7
3.5
1.9
0.0
100.0
672
Conization of cervix
0.0
10.8
28.3
29.7
17.1
8.3
4.6
1.2
0.0
100.0
673
Other excision or destruction of lesion or tissue of

cervix
0.0
20.2
31.7
24.2
15.6
5.5
2.3
0.6
0.0
100.0
674
Amputation of cervix
0.3
1.2
6.5
19.9
19.6
19.0
19.0 14.5
0.0
100.0
675
Repair of internal cervical os
0.0
12.3
59.1
27.6
0.6
0.2
0.1
0.0
0.0
100.0
676
Other repair of cervix
0.0
15.9
37.0
29.2
12.7
2.3
2.6
0.3
0.0
100.0
680
Hysterotomy
1.5
15.4
26.2
16.9
16.9
6.2
7.7
9.2
0.0
100.0
681
Diagnostic procedures on uterus and supporting

structures
0.1
6.8
22.0
28.2
26.6
9.8
4.8
1.8
0.0
100.0
682
Excision or destruction of lesion or tissue of uterus
0.0
5.6
20.3
35.1
25.7
8.2
3.8
1.3
0.0
100.0
683
Subtotal abdominal hysterectomy
0.0
1.6
9.4
39.2
35.3
6.2
5.8
2.5
0.0
100.0
684
Total abdominal hysterectomy
0.0
0.3
9.5
37.2
37.1
8.0
5.2
2.6
0.0
100.0
685
Vaginal hysterectomy
0.0
0.3
9.1
31.9
27.0
11.7
13.1
7.1
0.0
100.0
686
Radical abdominal hysterectomy
0.0
0.3
9.9
24.4
19.8
18.3
17.2 10.1
0.0
100.0
687
Radical vaginal hysterectomy
0.0
0.0
6.7
30.0
23.3
20.0
16.7
3.3
0.0
100.0
688
Pelvic evisceration
0.0
0.0
14.7
11.8
14.7
22.1
20.6 16.2
0.0
100.0
689
Other and unspecified hysterectomy
0.0
1.0
11.5
36.8
32.9
9.1
4.4
4.4
0.0
100.0
690
Dilation and curettage of uterus
0.1
13.3
31.3
27.3
17.5
6.2
3.1
1.2
0.0
100.0
691

and supporting structures
0.3
23.7
40.5
26.6
7.3
0.8
0.6
0.2
0.0
100.0
692
Repair of uterus supporting structures
0.0
9.5
28.1
19.5
11.8
10.9
13.4
6.8
0.0
100.0
693
Paracervical uterine denervation
0.9
33.3
38.2
23.7
3.9
0.0
0.0
0.0
0.0
100.0
694
Uterine repair
0.0
19.6
43.9
22.4
5.6
2.8
3.7
1.9
0.0
100.0
695
Aspiration curettage of uterus
0.3
37.2
43.1
18.7
0.7
0.1
0.0
0.0
0.0
100.0
152
AMWAC 1998.6
696
Menstrual extraction or regulation
0.0
75.0
0.0
25.0
0.0
0.0
0.0
0.0
0.0
100.0
697
Insertion of intrauterine contraceptive device
0.1
14.0
41.0
35.8
9.1
0.1
0.0
0.0
0.0
100.0
699
Other operations on uterus, cervix, and supporting

structures
0.1
3.3
49.3
42.3
2.5
1.0
1.1
0.5
0.0
100.0
700
Culdocentesis
1.2
27.8
36.4
24.5
7.3
1.7
0.8
0.4
0.0
100.0
701
Incision of vagina and cul-de-sac
0.4
4.6
48.6
41.6
2.6
0.9
0.7
0.5
0.0
100.0
702
Diagnostic procedures on vagina and cul-de-sac
1.2
22.9
31.4
21.6
11.9
5.2
3.6
2.1
0.0
100.0
703
Local excision or destruction of vagina and cul-desac
1.2
25.9
31.1
21.3
10.6
5.2
3.1
1.5
0.0
100.0
704
Obliteration and total excision of vagina
3.5
0.0
5.9
14.1
20.0
16.5
28.2 11.8
0.0
100.0
705
Repair of cystocele and rectocele
0.0
0.2
4.2
15.6
23.7
21.0
23.7 11.5
0.0
100.0
706
Vaginal construction and reconstruction
6.4
14.1
17.9
21.8
15.4
7.7
11.5
5.1
0.0
100.0
707
Other repair of vagina
1.7
3.4
7.9
17.1
24.5
19.1
18.6
7.6
0.0
100.0
708
Obliteration of vaginal vault
0.0
0.0
3.6
9.0
16.1
20.4
27.6 23.3
0.0
100.0
709
Other operations on vagina and cul-de-sac
0.3
1.0
4.6
11.6
21.7
19.2
26.6 15.0
0.0
100.0
710
Incision of vulva and perineum
10.6
19.6
30.6
15.6
10.3
6.7
2.5
0.0
100.0
711
Diagnostic procedures on vulva
1.5
8.8
13.9
17.2
16.1
13.8
17.2 11.5
0.0
100.0
712
Operations on Bartholin's gland
0.2
17.4
32.2
28.9
15.9
3.4
1.6
0.5
0.0
100.0
713
Other local excision or destruction of vulva and

perineum
1.3
32.1
24.1
16.8
11.9
5.8
4.9
3.1
0.0
100.0
714
Operations on clitoris
45.2
7.1
11.9
9.5
4.8
4.8
4.8 11.9
0.0
100.0
715
Radical vulvectomy
1.1
0.0
2.2
5.4
14.0
15.1
26.9 35.5
0.0
100.0
716
Other vulvectomy
2.3
7.3
10.5
14.5
15.5
14.5
20.5 15.0
0.0
100.0
717
Repair of vulva and perineum
14.0
14.1
26.3
14.4
11.0
8.2
7.0
4.8
0.1
100.0
718
Other operations on vulva
10.4
32.0
22.4
19.2
7.2
4.8
2.4
1.6
0.0
100.0
719
Other operations on female genital organs
2.4
25.1
35.9
22.8
8.4
1.8
0.6
3.0
0.0
100.0
Total
0.3
13.3
30.9
27.9
15.8
6.0
4.0
1.8
0.0
100.0
4.1
Table I6: Percentages of obstetrical procedures (ICD-9-CM groupings) undertaken on patients (both public and private) in
given age categories, Australia, 199596
Age (years)
Procedure
Per cent
75+ Unkn.
Total
014
1524
2534
3544
4554
5564
720 Low forceps operation
0.0
19.4
64.1
16.5
0.1
0.0
0.0
0.0
100.0
721 Low forceps operation with episiotomy
0.1
22.0
65.6
12.3
0.1
0.0
0.0
0.0
100.0
722 Mid forceps operation
0.0
20.4
66.8
12.7
0.1
0.0
0.0
0.0
100.0
723 High forceps operation
0.0
18.9
68.9
12.2
0.0
0.0
0.0
0.0
100.0
724 Forceps rotation of fetal head
0.0
19.4
66.5
13.9
0.2
0.0
0.0
0.0
100.0
725 Breech extraction
0.1
18.9
63.4
17.5
0.1
0.0
0.0
0.0
100.0
726 Forceps application to aftercoming head
0.0
15.2
70.7
14.1
0.0
0.0
0.0
0.0
100.0
727 Vacuum extraction
0.1
22.2
64.8
12.9
0.1
0.0
0.0
0.0
100.0
728 Other specified instrumental delivery
0.0
12.9
74.2
12.9
0.0
0.0
0.0
0.0
100.0
729 Unspecified instrumental delivery
0.0
22.1
67.5
10.4
0.0
0.0
0.0
0.0
100.0
730 Artificial rupture of membranes
0.1
26.5
61.5
11.9
0.0
0.0
0.0
0.0
100.0
731 Other surgical induction of labour
0.0
28.2
57.1
14.4
0.0
0.3
0.0
0.0
100.0
732 Internal and combined version and extraction
0.9
22.9
55.0
20.2
0.9
0.0
0.0
0.0
100.0
733 Failed forceps
0.1
23.0
64.8
12.1
0.0
0.0
0.0
0.0
100.0
734 Medical induction of labour
0.0
24.1
62.6
13.2
0.1
0.0
0.0
0.0
100.0
735 Manually assisted labour
0.0
27.5
59.7
12.7
0.1
0.0
0.0
0.0
100.0
736 Episiotomy
0.1
23.8
63.7
12.3
0.0
0.0
0.0
0.0
100.0
738 Operations on fetus to facilitate delivery
0.7
33.1
44.8
20.7
0.7
0.0
0.0
0.0
100.0
153
AMWAC 1998.6
739 Other operations assisting delivery
0.0
21.4
63.4
15.2
0.0
0.0
0.0
0.0
100.0
740 Classical caesarian section
0.3
14.2
58.5
26.7
0.3
0.0
0.0
0.0
100.0
741 Low cervical caesarian section
0.0
16.6
64.2
19.0
0.1
0.0
0.0
0.0
100.0
742 Extraperitoneal caesarian section
0.0
16.7
83.3
0.0
0.0
0.0
0.0
0.0
100.0
743 Removal of extratubal ectopic pregnancy
0.0
22.0
61.0
17.1
0.0
0.0
0.0
0.0
100.0
744 Caesarian section of other specified type
0.0
18.8
75.0
6.3
0.0
0.0
0.0
0.0
100.0
749 Caesarian section of unspecified type
0.0
9.6
67.3
21.2
1.9
0.0
0.0
0.0
100.0
750 Intra-amniotic injection for abortion
0.0
35.2
48.1
16.7
0.0
0.0
0.0
0.0
100.0
751 Diagnostic amniocentesis
0.0
15.6
43.0
41.0
0.4
0.0
0.0
0.0
100.0
752 Intrauterine transfusion
1.0
11.8
56.9
30.4
0.0
0.0
0.0
0.0
100.0
753 Other intrauterine operations on fetus and

amnion
0.1
33.2
54.9
11.8
0.1
0.0
0.0
0.0
100.0
754 Manual removal of retained placenta
0.1
21.4
61.5
16.9
0.1
0.0
0.0
0.0
100.0
755 Repair of current obstetric laceration of uterus
0.0
24.7
54.3
21.0
0.0
0.0
0.0
0.0
100.0
756 Repair of other current obstetric laceration
0.0
22.8
63.7
13.4
0.0
0.0
0.0
0.0
100.0
757 Manual exploration of uterine cavity, postpartum
0.4
24.2
59.1
16.3
0.0
0.0
0.0
0.0
100.0
758 Obstetric tamponade of uterus or vagina
0.0
33.3
48.7
17.9
0.0
0.0
0.0
0.0
100.0
759 Other obstetric operations
0.7
20.3
60.8
15.8
1.4
0.7
0.3
0.0
100.0
0.1
23.8
62.4
13.7
0.1
0.0
0.0
0.0
100.0
Total
Table I7: Gynaecological procedures (ICD-9-CM groupings) undertaken on private patients as a percentage of total gynaecological
procedures undertaken in given age categories, Australia, 199596
Age (years) Per cent
Procedure
014 1524 2534 3544 4554 5564 6574
75+ Unkn. Total
650
Oophorotomy
0.0
22.2
33.2
42.5
34.0
55.6
25.0
20.0
651
57.1
43.8
60.1
58.1
64.4
46.2
37.9
28.0
n.a. 55.5
652
Local excision or destruction of ovarian lesion or tissue
54.1
41.2
53.9
58.8
61.8
68.4
56.3
52.9
n.a. 53.9
653
12.5
34.6
38.4
45.7
56.6
51.0
47.4
36.3
n.a. 46.0
654
26.9
28.5
35.2
49.0
58.7
54.2
46.2
48.8
n.a. 48.6
655
66.7
60.0
31.4
40.6
57.0
59.7
45.2
49.2
n.a. 49.7
656
40.0
33.3
39.1
45.7
53.5
54.0
44.1
39.9
n.a. 49.7
657
Repair of ovary
14.3
26.9
32.2
44.8
76.5
100.0
0.0
0.0
n.a. 37.8
658
25.0
42.2
50.6
57.2
56.6
60.7
46.2
57.1
n.a. 52.7
659
38.5
53.5
84.0
86.9
64.1
64.4
43.6
58.3
n.a. 81.0
660
0.0
13.8
35.1
50.7
44.8
25.0
100.0
0.0
n.a. 34.4
661
33.3
63.9
88.1
89.6
72.7
33.3
0.0
0.0
n.a. 85.0
662
Bilateral endoscopic destruction or occlusion of fallopian

tubes
n.a.
11.3
27.9
45.1
57.9
100.0
n.a.
n.a.
n.a. 36.5
663
Other bilateral destruction or occlusion of fallopian tubes
50.0
12.0
27.9
43.5
70.0
100.0
n.a.
n.a.
n.a. 33.8
664
33.3
23.1
35.8
48.7
65.3
65.4
61.5
50.0
n.a. 47.8
665
n.a.
20.0
32.6
42.8
47.7
40.0
48.1
11.1
n.a. 40.5
666
Other salpingectomy
52.6
22.8
33.5
44.3
59.1
57.5
33.3
16.7
n.a. 36.4
667
n.a.
24.3
33.1
49.6
62.5
0.0
n.a.
n.a.
n.a. 40.0
668
100.0
41.1
60.5
66.0
67.3
0.0
50.0 100.0
n.a. 59.3
669
75.0
86.5
92.0
92.1
76.1
44.4
100.0
0.0
n.a. 91.3
670
33.3
42.1
55.3
66.2
69.4
53.4
46.7
40.0
n.a. 56.9
671
16.7
27.2
34.0
42.9
49.7
39.9
31.7
31.0
n.a. 36.9
672
0.0
25.4
33.7
42.1
50.1
45.6
32.9
37.9 100.0 39.1
154
AMWAC 1998.6
n.a. 34.2
673
Other excision or destruction of lesion or tissue of cervix
28.6
34.1
42.4
52.5
57.2
55.1
45.9
39.4
674
0.0
50.0
40.9
59.7
56.1
50.0
46.9
57.1
n.a. 52.8
675
n.a.
15.0
51.7
63.3
60.0
0.0
100.0
n.a.
n.a. 50.3
676
n.a.
20.4
28.1
46.7
41.0
28.6
25.0
0.0
n.a. 33.8
680
Hysterotomy
0.0
20.0
11.8
45.5
27.3
50.0
20.0
50.0
n.a. 27.7
681
Diagnostic
structures
59.2
44.6
56.7
56.7
58.1
55.9
47.8
41.0 100.0 55.5
682
100.0
52.5
60.1
62.1
64.3
59.3
48.8
35.0
n.a. 60.6
683
n.a.
57.1
34.1
41.8
51.0
25.9
32.0
27.3
n.a. 42.6
684
50.0
23.4
32.3
47.7
55.2
51.3
42.8
37.6
n.a. 48.7
685
n.a.
29.3
36.4
50.2
60.0
54.6
47.3
47.0
n.a. 51.4
686
n.a.
0.0
26.2
38.0
57.4
59.3
57.5
61.3
n.a. 50.2
687
n.a.
n.a.
50.0
11.1
57.1
66.7
60.0
0.0
n.a. 43.3
688
Pelvic evisceration
n.a.
n.a.
40.0
62.5
40.0
53.3
28.6
9.1
n.a. 38.2
689
n.a.
60.0
39.7
50.0
54.2
67.4
36.4
40.9
n.a. 50.9
690
35.8
30.5
43.5
50.5
55.2
54.1
46.4
41.0 100.0 46.4
691
Excision or destruction of lesion or tissue of uterus and

supporting structures
30.8
44.0
57.3
62.3
64.4
36.4
51.9
25.0 100.0 55.7
692
n.a.
22.6
39.9
52.8
49.4
54.2
51.1
49.4
n.a. 45.6
693
50.0
73.7
70.1
77.8
100.0
n.a.
n.a.
n.a.
n.a. 74.1
694
Uterine repair
n.a.
14.3
40.4
58.3
66.7
66.7
25.0
50.0
n.a. 41.1
695
52.2
49.3
50.1
54.5
48.6
25.0
28.6
10.0
58.3 50.6
696
n.a.
66.7
n.a.
0.0
n.a.
n.a.
n.a.
n.a.
n.a. 50.0
697
0.0
26.3
37.9
50.1
65.0
100.0
n.a.
n.a.
n.a. 43.2
699
Other operations on uterus, cervix, and supporting

structures
25.0
56.2
89.1
92.9
81.0
36.5
35.8
56.5
n.a. 88.1
700
Culdocentesis
44.4
53.0
72.2
79.9
66.1
84.6
50.0
33.3
n.a. 67.9
701
32.0
80.7
93.7
94.1
74.0
61.0
55.7
67.2
n.a. 91.8
702
31.6
26.5
33.8
40.5
45.6
40.9
33.4
36.8 100.0 35.4
703
Local excision or destruction of vagina and cul-de-sac
47.5
45.6
58.8
62.1
63.8
63.7
60.1
46.2 100.0 56.6
704
66.7
n.a.
40.0
33.3
58.8
57.1
58.3
50.0
n.a. 52.9
705
100.0
27.5
38.8
53.4
58.8
54.2
48.1
47.0
n.a. 52.2
706
40.0
63.6
85.7
94.1
83.3
100.0
88.9
50.0
n.a. 80.8
707
26.5
34.8
43.7
53.0
58.1
57.6
52.5
50.3
n.a. 53.0
708
n.a.
n.a.
40.0
36.0
75.6
61.4
44.2
44.6
n.a. 52.0
709
66.7
52.6
60.2
55.0
65.2
58.2
52.5
46.7
n.a. 56.1
710
37.7
34.6
47.2
47.3
58.2
51.7
52.8
43.8
n.a. 45.3
711
22.7
45.6
45.2
50.0
49.8
42.9
34.0
31.3
n.a. 42.6
712
16.7
26.6
37.5
44.8
54.6
47.6
38.3
40.0
n.a. 40.7
713
Other local excision or destruction of vulva and perineum
40.9
40.8
47.7
50.4
58.6
54.6
45.2
47.2
n.a. 47.4
714
31.6
0.0
60.0
25.0
100.0
50.0
0.0
80.0
n.a. 40.5
715
Radical vulvectomy
0.0
n.a.
0.0
0.0
30.8
35.7
40.0
36.4
n.a. 33.3
716
Other vulvectomy
20.0
50.0
39.1
71.9
41.2
46.9
42.2
33.3
n.a. 45.5
717
26.9
28.2
49.6
56.7
65.7
61.8
44.6
44.4 100.0 46.7
718
30.8
35.0
67.9
66.7
66.7
66.7
0.0
0.0
n.a. 50.4
719
0.0
40.5
38.3
42.1
35.7
66.7
0.0
20.0
n.a. 38.3
38.2
39.0
50.4
55.9
56.8
54.0
46.4
43.0
82.1 51.3
procedures
on
uterus
Total
and supporting
155
AMWAC 1998.6
n.a. 46.2
Table I8: Obstetrical procedures (ICD-9-CM groupings) undertaken on private patients as a percentage of total
Obstetrical procedures undertaken in given age categories, Australia, 199596
Age (years) Per cent
Procedure
014 1524 2534 3544 4554 5564
75+ Unkn.
Total
720 Low forceps operation
n.a.
19.2
56.4
62.1
0.0
n.a.
n.a.
n.a.
50.1
721 Low forceps operation with episiotomy
0.0
15.5
50.8
59.0
25.0
n.a.
n.a.
n.a.
44.0
722 Mid forceps operation
0.0
20.5
55.5
62.6
33.3
n.a.
n.a.
n.a.
49.2
723 High forceps operation
n.a.
18.5
57.4
65.7
n.a.
n.a.
n.a.
n.a.
51.0
724 Forceps rotation of fetal head
0.0
18.7
56.7
63.7
16.7
n.a.
n.a.
n.a.
50.2
28.0
725 Breech extraction
100.0
4.7
33.2
34.3
0.0
n.a.
n.a.
n.a.
726 Forceps application to aftercoming head
n.a.
0.0
35.4
53.8
n.a.
n.a.
n.a.
n.a.
32.6
727 Vacuum extraction
0.0
13.4
46.0
55.3
42.9
n.a.
n.a.
n.a.
39.9
728 Other specified instrumental delivery
n.a.
25.0
60.9
75.0
n.a.
n.a.
n.a.
n.a.
58.1
729 Unspecified instrumental delivery
n.a.
11.8
50.0
37.5
n.a.
n.a.
n.a.
n.a.
40.3
730 Artificial rupture of membranes
7.0
10.4
40.6
49.2
46.7
0.0
n.a.
n.a.
33.6
731 Other surgical induction of labour
n.a.
13.3
39.9
56.0
n.a.
100.0
n.a.
n.a.
34.9
100.0
4.0
33.3
50.0
0.0
n.a.
n.a.
n.a.
30.3
733 Failed forceps
0.0
16.3
44.0
51.1
n.a.
n.a.
n.a.
n.a.
38.5
734 Medical induction of labour
9.1
12.5
44.1
52.2
50.0
n.a.
n.a.
n.a.
37.5
735 Manually assisted labour
0.0
6.6
32.4
41.2
66.7
n.a.
n.a.
n.a.
26.4
736 Episiotomy
0.0
12.2
45.9
53.2
62.5
100.0
n.a.
n.a.
38.7
732 Internal and combined version and extraction
738 Operations on fetus to facilitate delivery
100.0
54.2
40.0
50.0
100.0
n.a.
n.a.
n.a.
47.6
739 Other operations assisting delivery
n.a.
1.1
17.1
25.4
n.a.
n.a.
n.a.
n.a.
14.9
740 Classical caesarian section
0.0
12.0
41.3
54.3
0.0
n.a.
n.a.
n.a.
40.3
741 Low cervical caesarian section
9.1
13.3
45.1
53.0
49.2
0.0
n.a.
n.a.
41.3
742 Extraperitoneal caesarian section
n.a.
0.0
60.0
n.a.
n.a.
n.a.
n.a.
n.a.
50.0
743 Removal of extratubal ectopic pregnancy
n.a.
16.7
46.0
35.7
n.a.
n.a.
n.a.
n.a.
37.8
744 Caesarian section of other specified type
n.a.
0.0
41.7
0.0
n.a.
n.a.
n.a.
n.a.
31.3
749 Caesarian section of unspecified type
n.a.
0.0
40.0
63.6
100.0
n.a.
n.a.
n.a.
42.3
750 Intra-amniotic injection for abortion
n.a.
21.1
42.3
44.4
n.a.
n.a.
n.a.
n.a.
35.2
751 Diagnostic amniocentesis
n.a.
2.8
14.6
26.3
0.0
n.a.
n.a.
n.a.
17.5
752 Intrauterine transfusion
0.0
0.0
17.2
32.3
n.a.
n.a.
n.a.
n.a.
19.6
753 Other intrauterine operations on fetus and amnion
0.0
3.7
19.2
27.5
13.6
n.a.
n.a.
n.a.
15.0
754 Manual removal of retained placenta
0.0
6.7
34.4
42.3
57.1
n.a.
n.a.
n.a.
29.8
755 Repair of current obstetric laceration of uterus
n.a.
5.6
30.4
23.0
n.a.
n.a.
n.a.
n.a.
22.7
756 Repair of other current obstetric laceration
2.8
10.2
39.8
48.5
30.8
n.a.
100.0
100.0
34.2
26.1
757 Manual exploration of uterine cavity, postpartum
0.0
1.6
34.6
32.6
n.a.
n.a.
n.a.
n.a.
758 Obstetric tamponade of uterus or vagina
n.a.
30.8
36.8
28.6
n.a.
n.a.
n.a.
n.a.
33.3
759 Other obstetric operations
0.0
15.3
48.0
43.5
25.0
50.0
100.0
n.a.
40.2
5.7
10.6
41.1
49.2
41.6
50.0
100.0
100.0
34.9
Total
156
AMWAC 1998.6
Table I9: Relative growth in gynaecological procedures (ICD-9-CM groupings), Australia, 199394 to 199596
Procedure
199394
199495
199596
% increase
199394 to
199596
709
136
180
1,822
1239.7
689
179
314
505
182.1
696
100.0
661
281
373
514
82.9
706
693
660
687
691
Excision or destruction of lesion or tissue of uterus and supporting

structures
702
717
681
Diagnostic procedures on uterus and supporting structures
52,663
66,317
66,759
26.8
671
8,341
11,444
10,395
24.6
669
4,713
5,261
5,840
23.9
703
4,212
4,712
5,213
23.8
707
3,339
3,657
4,039
21.0
673
27,722
35,941
33,039
19.2
650
Oophorotomy
757
932
895
18.2
714
36
60
42
16.7
670
1,106
1,672
1,285
16.2
699
Other operations on uterus, cervix, and supporting structures
659
710
701
685
652
676
695
657
Repair of ovary
716
Other vulvectomy
658
656
46
68
78
69.6
139
201
228
64.0
1,203
1,577
1,669
38.7
22
19
30
36.4
3,297
3,716
4,249
28.9
13,420
17,754
17,257
28.6
730
849
928
27.1
4,280
4,641
4,957
15.8
15,149
16,398
17,464
15.3
1,135
1,170
1,299
14.4
10,386
11,366
11,846
14.1
12,814
14,235
14,572
13.7
7,760
8,564
8,796
13.4
272
341
308
13.2
46,620
50,981
52,431
12.5
260
289
291
11.9
199
271
220
10.6
4,392
4,598
4,832
10.0
8,900
9,959
9,773
9.8
705
15,925
16,990
17,362
9.0
664
682

Total
718
680
Hysterotomy
654
668
655
666
712
829
850
901
8.7
11,109
11,781
12,053
8.5
498,590
548,047
536,950
7.7
117
135
125
6.8
61
50
65
6.6
5.6
4,648
4,978
4,907
11,757
11,935
12,291
4.5
964
1,043
1,007
4.5
Other salpingectomy
3,211
3,298
3,334
3.8
2,928
3,143
3,032
3.6
713
4,968
5,006
5,097
2.6
683
653
157
424
463
434
2.4
2,520
2,575
2,554
1.3
AMWAC 1998.6
715
Radical vulvectomy
711
651
663
688
Pelvic evisceration
665
662
Bilateral endoscopic destruction or occlusion of fallopian tubes
694
Uterine repair
690
686
684
675
672
697
92
96
93
1,420
1,555
1,420
1.1
0.0
981
1,199
965
-1.6
5,217
5,262
5,112
-2.0
70
75
68
-2.9
772
767
749
-3.0
20,896
19,919
19,980
-4.4
112
103
107
-4.5
138,511
141,859
131,605
-5.0
-5.7
653
686
616
20,910
21,028
19,371
-7.4
948
876
868
-8.4
5,113
5,937
4,680
-8.5
2,148
1,923
1,951
-9.2
692
1,485
1,463
1,303
-12.3
674
387
402
337
-12.9
667
1,973
1,745
1,680
-14.9
700
Culdocentesis
1,083
953
772
-28.7
719
256
240
167
-34.8
704
142
158
85
-40.1
708
1,449
1,692
279
-80.7
Table I10: Relative growth in obstetrical procedures (ICD-9-CM groupings) , Australia, 199394 to 199596
Procedure
199394
199495
199596
% increase
199394 to
199596
11
145
1971.4
11,512
20,822
26,723
132.1
17
33
39
129.4
28,768
33,670
47,544
65.3
738
753
758
734
739
275
335
415
50.9
757
176
230
264
50.0
752
74
128
102
37.8
759
18.3
727
Vacuum extraction
755

Total
246
279
291
8,540
9,559
10,028
17.4
253
281
291
15.0
317,522
345,036
355,039
11.8
697
745
775
11.2
68,454
74,396
75,564
10.4
733
Failed forceps
730
751
430
419
463
7.7
756
70,750
75,603
74,749
5.7
735
14,624
16,932
14,699
0.5
742
732
754
741
744
724
725
0.0
111
138
109
-1.8
5,497
5,854
5,393
-1.9
48,057
48,575
47,123
-1.9
17
25
16
-5.9
3,625
3,484
3,389
-6.5
Breech extraction
1,597
1,672
1,449
-9.3
158
AMWAC 1998.6
721
740
5,818
5,376
5,162
-11.3
400
477
352
736
-12.0
Episiotomy
29,778
28,828
26,204
-12.0
722
13,568
13,168
11,649
-14.1
720
1,296
1,281
1,074
-17.1
723
347
310
286
-17.6
750
107
78
54
-49.5
729
212
129
77
-63.7
726
268
162
92
-65.7
743
-73.5
731
749
728
310
164
82
1,315
1,677
347
-73.6
207
85
52
-74.9
163
104
31
-81.0
Table I11: Percentage of gynaecological procedures (ICD-9-CM groupings) undertaken on private patients (a) sorted by
extent of private involvement, Australia 199596
Procedure
% of
procedures on
private
patients
Total
procedures
(public&
private
patients) (no.)
11,846
701
91.8
669
91.3
5,840
699
Other operations on uterus, cervix, and supporting structures
88.1
4,957
661
85.0
514
659
81.0
17,464
706
80.8
78
693
74.1
228
700
Culdocentesis
67.9
772
682
60.6
12,053
668
59.3
12,291
670
56.9
1,285
703
56.6
5,213
709
56.1
1,822
691
Excision or destruction of lesion or tissue of uterus and supporting structures
55.7
4,249
651
55.5
965
681
Diagnostic procedures on uterus and supporting structures
55.5
66,759
652
53.9
8,796
707
53.0
4,039
704
52.9
85
674
52.8
337
658
52.7
4,832
705
52.2
17,362
708
52.0
279
685
51.4
14,572
536,950
Total
51.3
689
50.9
505
695
50.6
52,431
718
50.4
125
675
50.3
868
686
50.2
616
159
AMWAC 1998.6
696
50.0
655
49.7
1,007
656
49.7
9,773
684
48.7
19,371
654
48.6
4,907
664
47.8
901
713
47.4
5,097
717
46.7
928
690
46.4
131,605
673
46.2
33,039
653
46.0
2,554
692
45.6
1,303
716
Other vulvectomy
45.5
220
710
45.3
1,299
687
43.3
30
697
43.2
1,951
683
42.6
434
711
42.6
1,420
694
Uterine repair
41.1
107
712
40.7
3,032
665
40.5
749
714
40.5
42
667
40.0
1,680
672
39.1
4,680
719
38.3
167
688
Pelvic evisceration
38.2
68
657
Repair of ovary
37.8
291
671
36.9
10,395
662
Bilateral endoscopic destruction or occlusion of fallopian tubes
36.5
19,980
666
Other salpingectomy
36.4
3,334
702
35.4
17,257
660
34.4
1,669
650
Oophorotomy
34.2
895
663
33.8
5,112
676
33.8
308
715
Radical vulvectomy
33.3
93
680
Hysterotomy
27.7
65

(a) Private and public patients have been classifed according to the 'patient accommodation status' data field. This field is defined
in accordance with the National Health Data Dictionary. Private patients in this table comprise 'eligible private patients' and
'ineligible patients', public patients comprise 'eligible public patients', 'eligible DVA patients' and eligible other patients'.
160
AMWAC 1998.6
Table I12: Percentage of obstetrical procedures (ICD-9-CM groupings) undertaken on private patients (a) sorted by extent of
private involvement, Australia 199596
Procedure
% of procedures on private
patients
Total procedures (public&

private patients) (no.)
31
728
58.1
723
51.0
286
724
50.2
3,389
720
50.1
1,074
742
50.0
722
49.2
11,649
738
47.6
145
721
44.0
5,162
749
42.3
52
741
41.3
47,123
729
40.3
77
740
40.3
352
759
40.2
291
727
Vacuum extraction
39.9
10,028
736
Episiotomy
38.7
26,204
733
Failed forceps
38.5
775
743
37.8
82
734
37.5
47,544
750
35.2
54
731
34.9
347
Tot
Total
34.9
355,039
756
34.2
74,749
730
33.6
75,564
758
33.3
39
726
32.6
92
744
31.3
16
732
30.3
109
754
29.8
5,393
725
Breech extraction
28.0
1,449
735
26.4
14,699
757
26.1
264
755
22.7
291
752
19.6
102
751
17.5
463
753
15.0
26,723
739
14.9
415

(a) Private and public patients have been classified according to the 'patient accommodation status' data field. This field is
defined in accordance with the National Health Data Dictionary. Private patients in this table comprise 'eligible private patients'
and 'ineligible patients', public patients comprise 'eligible public patients', 'eligible DVA patients' and eligible other patients'.
161
AMWAC 1998.6
Table I13: Projected (a) gynaecological procedures (ICD-9-CM groupings) for 1998 and 2018, Australia
Procedure
715 Radical vulvectomy
708 Obliteration of vaginal vault
709 Other operations on vagina and cul-de-sac
705 Repair of cystocele and rectocele
1998
2018
Forecast growth
forecast
forecast
1998 to 2018
(no.)
(no.)
(per cent)
49.6
98
147
294
438
49.0
1,915
2,776
44.9
18,274
26,200
43.4
688 Pelvic evisceration
71
102
42.3
704 Obliteration and total excision of vagina
89
126
42.0
674 Amputation of cervix

707 Other repair of vagina
716 Other vulvectomy
355
495
39.4
4,240
5,828
37.5
230
314
36.7
686 Radical abdominal hysterectomy
647
878
35.7
656 Bilateral salpingo-oophorectomy
10,404
14,034
34.9
32
42
34.3
711 Diagnostic procedures on vulva
1,481
1,965
32.7
655 Bilateral oophorectomy
1,067
1,395
30.7
15,359
19,703
28.3
1,350
1,684
24.8
687 Radical vaginal hysterectomy
685 Vaginal hysterectomy

692 Repair of uterus supporting structures
706 Vaginal construction and reconstruction
689 Other and unspecified hysterectomy
684 Total abdominal hysterectomy
680 Hysterotomy
683 Subtotal abdominal hysterectomy
681 Diagnostic procedures on uterus and supporting structures
653 Unilateral oophorectomy
717 Repair of vulva and perineum
682 Excision or destruction of lesion or tissue of uterus
714 Operations on clitoris
81
98
21.8
534
647
21.2
20,527
24,831
21.0
67
81
20.4
459
549
19.6
69,947
83,619
19.5
2,676
3,186
19.0
956
1,131
18.3
12,636
14,813
17.2
43
50
16.5
672 Conization of cervix
4,860
5,638
16.0
713 Other local excision or destruction of vulva and perineum
5,221
6,032
15.5
654 Unilateral salpingo-oophorectomy
5,153
5,935
15.2
710 Incision of vulva and perineum
1,334
1,525
14.3
556,291
633,907
14.0
784
891
13.7
690 Dilation and curettage of uterus
136,472
155,104
13.7
671 Diagnostic procedures on cervix
10,711
12,171
13.6
1,326
1,499
13.0
702 Diagnostic procedures on vagina and cul-de-sac
17,742
20,051
13.0
673 Other excision or destruction of lesion or tissue of cervix
34,091
38,302
12.4
5,346
6,004
12.3
651 Diagnostic procedures on ovaries
998
1,120
12.2
718 Other operations on vulva
128
142
11.5
Total
665 Total bilateral salpingectomy
670 Dilation of cervical canal
703 Local excision or destruction of vagina and cul-de-sac
664 Total unilateral salpingectomy
939
1,040
10.7
3,133
3,449
10.1
694 Uterine repair
110
120
9.1
676 Other repair of cervix
317
345
8.8
719 Other operations on female genital organs
171
185
8.1
9,038
9,682
7.1
789
842
6.7
712 Operations on Bartholin's gland
652 Local excision or destruction of ovarian lesion or tissue

700 Culdocentesis
162
AMWAC 1998.6
696 Menstrual extraction or regulation
6.7
4,990
5,323
6.7
921
978
6.2
691 Excision or destruction of lesion or tissue of uterus and supporting struct
4,346
4,584
5.5
666 Other salpingectomy
658 Lysis of adhesions of ovary and fallopian tube

650 Oophorotomy
3,417
3,575
4.6
657 Repair of ovary
298
312
4.6
693 Paracervical uterine denervation
232
242
4.2
4.2
697 Insertion of intrauterine contraceptive device
2,009
2,094
53,008
54,961
3.7
5,111
5,284
3.4
659 Other operations on ovary
17,970
18,557
3.3
701 Incision of vagina and cul-de-sac
12,206
12,597
3.2
528
542
2.7
695 Aspiration curettage of uterus

699 Other operations on uterus, cervix, and supporting structures
661 Diagnostic procedures on fallopian tubes

660 Salpingotomy and salpingostomy
662 Bilateral endoscopic destruction or occlusion of fallopian tubes
1,702
1,747
2.7
20,620
21,013
1.9
888
904
1.9
675 Repair of internal cervical os

668 Insufflation of fallopian tube
12,557
12,787
1.8
669 Other operations on fallopian tubes
6,003
6,112
1.8
667 Repair of fallopian tube
1,729
1,754
1.4
663 Other bilateral destruction or occlusion of fallopian tubes
5,257
5,331
1.4
Sources: AIHW National Hospital Morbidity Database and ABS population data.
(a) The projections have been based on morbidity data for 199596.
Table I14: Projected (a) obstetrical procedures (ICD-9-CM groupings) for 1998 and 2018, Australia
Procedure
738
750
759
758
753
731
735
732
730
755
757
734
736
Episiotomy
756
733
Failed forceps
743
754
727
Vacuum extraction
721
751
1998
2018
Forecast growth
forecast
forecast
1998 to 2018
(no.)
(no.)
(per cent)
147
152
3.3
55
56
3.2
296
305
3.1
39
41
3.1
27,012
27,822
3.0
352
362
2.8
14,893
15,270
2.5
111
114
2.5
76,574
78,438
2.4
296
303
2.4
268
274
2.3
48,237
49,326
2.3
360,290
368,366
2.2
26,583
27,173
2.2
75,875
77,504
2.1
786
803
2.1
83
85
2.1
5,482
5,597
2.1
10,181
10,394
2.1
5,240
5,349
2.1
474
484
2.1
739
422
430
2.0
729
78
80
2.0
722
11,834
12,064
1.9
Total
163
AMWAC 1998.6
720
1,092
1,113
1.9
725
Breech extraction
1,474
1,503
1.9
724
3,445
3,511
1.9
723
1.8
741
740
744
749
291
296
48,005
48,842
1.7
360
366
1.7
16
17
1.7
53
54
1.7
726
94
95
1.5
752
104
106
1.5
742
1.4
728
32
32
1.3
Sources: AIHW National Hospital Morbidity Database and ABS population data.
(a) The projections have been based on morbidity data for 199596.
164
AMWAC 1998.6
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AMWAC 1998.6
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AMWAC 1998.6

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Australian Medical Workforce Advisory Committee

THE OBSTETRICS AND GYNAECOLOGY

AMWAC Report 1998.6

Australian Medical Workforce Advisory Committee 1998

Publication and design by Australian Medical Workforce Advisory Committee.

List of Tables and List of Figures

Terms of Reference of AMWAC and the AMWAC Obstetrics and

Membership of the AMWAC Obstetrics and Gynaecology Workforce

Introduction, Guiding Principles and Methodology

The Specialist Obstetrics and Gynaecology Workforce

Summary of Findings and Recommendations

Description of the Current Obstetrics and Gynaecology Workforce

Adequacy of the Current Obstetrics and Gynaecology Workforce

Balancing Supply Against Requirements

The Sub-Specialist Obstetrics and Gynaecology Workforces

Characteristics of the Obstetrics and Gynaecology Sub-specialist

Australian Bureau of Statistics

Australian Capital Territory

Australian Health Ministers' Advisory Council

Australian Institute of Health and Welfare

Australian Medical Workforce Advisory Committee

Australian National Diagnostic Related Groups

Certificate of Reproductive Endocrinology and Infertility

Certificate of Satisfactory Completion of Training in Womens

Commonwealth Department of Health and Family Services

Diploma of the Royal Australian College of Obstetricians and

Fellow of the Royal Australian College of Physicians

Full time equivalent

Health Insurance Commission

Hospital Medical Officer

International Classification of Diseases, Ninth Revision

Integrated Training Program

Medicare Benefits Schedule

Medical Diagnostic Category

Minimum Data Set

Maternal Fetal Medicine

Member of the Royal Australian College of Obstetricians and

National Association of Specialist Obstetricians and Gynaecologists

New South Wales

Obstetrics and Gynaecology

Obstetrical and Gynaecological Ultrasound

Royal Australian College of General Practitioners

Royal Australian College of Obstetricians and Gynaecologists

Rural, Remote Metropolitan Areas classification

Specialist Recognition Advisory Committee

Temporary Resident Doctor

Visiting Medical Officer

Obstetrics and gynaecology specialists to population, by State/Territory

Obstetrics and Gynaecology Specialists supply (Average Attrition Rates) vs

TERMS OF REFERENCE OF AMWAC AND THE AMWAC OBSTETRICS AND

To provide advice to AHMAC on a range of medical workforce matters, including:

the structure, balance and geographic distribution of the medical

To oversee the establishment and development of data collections concerned

Obstetrics and Gynaecology Workforce Working Party Terms of Reference

Assistant Secretary, Business and Temporary Entry

Director, Health Issues Centre

Secretary General, Australian Medical Association

First Assistant Secretary, Higher Education Division,

General Practitioner, Minlaton, South Australia

Assoc. Prof. Jane Hall

Director, Centre for Health, Economics, Research and

Director, Australian Institute of Health and Welfare

Secretary, Tasmanian Department of Community and

Professor Nick Saunders Dean, Faculty of Medicine, Monash University, Melbourne