The Distribution and Composition of Colonoscopy Providers in Australia

Abstract

Introduction: Colorectal cancer is a common cause of cancer in Australia. Also, patients living in regional and rural areas are diagnosed later and have poorer outcomes compared to their metropolitan counterparts. The purpose of this study is to determine the distribution of the workforce providing colonoscopies for the Australian population.Methods: A cross-sectional observational study of the medical practitioners certified by the conjoint committee for the recognition of training in gastrointestinal endoscopy (CCRTGE) was performed. Data regarding their specialty and principal place of practice was collected. The principal place of practice was stratified with the Modified Monash Model (MMM) of rurality and the local government association's classifications of rural and urban areas.Results: As of March 2021, there were 2698 medical practitioners listed as being recognised in the field of adult colonoscopies by the CCRTGE. Of these, 2123 were found to still have active specialist registration with the Australian Health Practitioner Regulation Agency (AHPRA). In the capital city Local Government Areas (LGAs), there was an endoscopist every 0.33 km 2 to 62.05 km 2 . In the rural LGAs, there was an endoscopist every 23,382 km 2 to 267,780 km 2 . In metropolitan areas, the most common specialty of the endoscopist was gastroenterology whereas in regional cities and remote towns it was general surgery. In very remote towns, general practitioners provided colonoscopy services.

The provision of general surgery in rural Australia: a narrative review

“…9 For example, rural South Australia (SA) has an endoscopist to population ratio of 1:55 000 compared with 1:500 for residents of Adelaide, with rural colonoscopies predominantly provided by general surgeons. 10 A smaller workforce and greater patient ratios result in general surgeons having a greater workloadrural specialists work up to 1.8 times more hours per week on average than metropolitan specialists. 8 On-call requirements can be onerous; for example, in Western Australia (WA), up to 83% of rural general surgeons perform on-call duties, at least 50% are on-call for one in four days (or fewer), and 7.5% are on-call for one in two days (or fewer).…”

“…Compared with their metropolitan counterparts, rural general surgeons cater for a greater surgeon to population ratio, with an extended scope of practice, and on average perform double the number of operations, primarily due to the provision of endoscopy services 9 . For example, rural South Australia (SA) has an endoscopist to population ratio of 1:55 000 compared with 1:500 for residents of Adelaide, with rural colonoscopies predominantly provided by general surgeons 10 . A smaller workforce and greater patient ratios result in general surgeons having a greater workload — rural specialists work up to 1.8 times more hours per week on average than metropolitan specialists 8 .…”