Lack of dermatologists in South seen as clinically unsafe

Retired dermatologist David Young says the Southern health system needs to boost spending on...
Retired dermatologist David Young says the Southern health system needs to boost spending on specialists rather than relying on GPs to take on the work. PHOTO: JULIE ASHER
A former dermatologist is "appalled" by the collapse of the public service after the last two general skin specialists quit the South.

Dr David Young had warned of problems with the service for years, but said the former Southern District Health Board (SDHB) "sat on its hands", unwilling to spend more money on dermatology.

A letter sent to GPs recently said both of the contractors who provided dermatology at Southland and Dunedin hospitals were withdrawing their services.

As of May 2024, neither would be available, the letter said.

DHB successor Health New Zealand Te Whatu Ora (HNZ) Southern did not answer questions about the situation asked by the ODT.

Dr Young, who retired in late 2022 at age 71, said it was an appalling situation, especially for Dunedin, a "so-called tertiary hospital".

The Clyde resident had worked at both hospitals during his career, and urged the SHDB — despite the lack of dermatologists in the country — to make genuine attempts to recruit more.

Several other parts of the country had advertised internationally, but it was not a solution taken seriously in the South.

"I tried for a long time ... I just got sick of beating my head against the brick wall."

His letter giving notice to leave his role at Dunedin Hospital in 2018 said he felt resignation was the only option, due to the senior management’s ongoing dismissive attitude.

Skin conditions could be serious, even life-threatening, and the situation was clinically unsafe, the letter said.

"There are a totally inadequate number of clinics."

A response letter provided to the ODT said the SDHB "would very much like to increase its funding" but had to make difficult decisions due to demands from other services.

Dr Young had most recently worked at Southland Hospital, along with one other part-time dermatologist, who commuted from Auckland and had also been nearing retirement.

He believed there was still one Dunedin dermatologist providing part-time skin cancer services to the public system, although the ODT was unable to reach the dermatologist yesterday to verify this.

Southern management seemed to think GPs could step in to make up for the lack of dermatologists, but despite doing their best, they did not have the training to do this, he said.

Telehealth services were also not an adequate alternative.

The letter notifying that the dermatology contractors for Southland and Dunedin hospitals were withdrawing their services was slammed by a Dunedin GP, who said there was a "Mickey Mouse health system".

It would push more work on to GPs without funding or consultation.

This follows the release of University of Otago research last week showing the risk of being declined by specialist services despite a GP referral was 54% in the Southern health district in 2022.

Dermatology would no longer be counted in such data, as now they simply could not refer patients, the GP said.

High-risk patients receiving care would be kept on the treatment regimes they had started, the letter said.

GPs could email HNZ Southern to reach a dermatologist if they needed endorsements to renew medication.

However, the email address was "not for referring new patients".

"We will also shortly be contacting all patients explaining that we are currently unable to provide dermatology appointments and to contact their General Practitioner should they have concerns."

New Zealand Dermatological Society co-president Dr Louise Reiche said the ideal ratio was about one specialist dermatologist for 80,000 people. However, this was based on a UK metric, and in Australia the recommended ratio was one per 40,000 people.

While urban centres such as Auckland were well serviced, the South fell "woefully short" of either ratio, and was competing with Northland for the lowest serviced area in the country.

The health system had a limited pot of money and looked on dermatology as a "Cinderella service".

However, there was a tsunami of skin cancer, and other skin issues could also have a major impact on people’s wellbeing and productivity.

She urged for more money to be spent on dermatology, as well international recruitment, more trainees, a shared record system, and better education for the public.

Bonding schemes or training subsidies could also encourage specialists to stay in the country.

Are you affected?