What are the possible solutions?
What we need is a long-term vision to tackle this problem. Obviously, we need more training positions, particularly in areas where the wait times are longest. Specifically, we need more developmental paediatricians. We also need to keep in mind that clinicians are currently carrying heavy caseloads, and there remains a risk of burnout – this can exacerbate the problem if people leave the health system altogether, or leave for other jurisdictions. Some thought must be given to rationalising people’s caseloads.
Recruiting more International Medical Graduates (IMGs) could help to boost our numbers, but that is not necessarily an easy solution to implement. We have to acknowledge, as Health Minister Meredith Hammat has articulated when talking about wait times, that WA is competing with every other state as well as internationally for a very small pool of specialists. And demand is growing faster across the country, and the training pipelines are too small.
The other issue is that when we’re parachuting in a person trained overseas, specialties like child development require knowledge of local systems and resources. So, IMGs need significant supervision and training as well, in a system where training is already limited due to already high workloads.
I believe the level of workforce pressure in paediatrics is not unique to WA, but is added to by our geographic isolation and spread which makes workforce distribution challenging. Telehealth has helped improve access for families in rural and regional areas. Workforce mobility for paediatric specialties both to urban and rural areas is required to ease geographic disparity in services and to deliver care closer to home.
While there is an investment in older adult community hubs by the Government, it would be good to see similar thought put to the paediatric community hubs to help with mobility of paediatric services in general. The fact remains that almost any solution to create better efficiency cannot be implemented without a larger workforce, and a need for a greater number of paediatric clinicians on the ground.
Looking to the long-term future, a lot of thought still needs to be given to support integration of services. This includes making funding available to pilot novel team-based care models that bridge between the silos of child development services, child and adolescent mental health services, and hospital services. We also need integration into the schools, where kids spend a significant portion of their lives.
I would hope that at some point we could embed OTs and speech pathologists into early education pathways, and start early in kindergarten and pre-kindergarten, where they reach out to identify children with difficulties as early as possible and provide support.
Early educators already do an amazing job of providing support to many vulnerable children, and often want and need guidance from developmental therapists to better help those with developmental differences. When we recognise that not all children learn in the same way, in school environments where accommodations and support are more universal, we often find all children benefit – not just those with the most need.
I write this final comment with awareness that our health system is under enormous pressure from an ageing population, with discourse being dominated by significant adult bed and ED pressures. I worry that in doing so, we forget about the littlest members of society and that their healthcare needs are equally urgent and important. The latest waitlist data represents their tiny cries for help.
