Many Illawarra children have no option but to travel to Sydney for routine surgery after the region's health district lost its only paediatric surgeon.
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It's been 18 months since surgeon Dr Wee Yan Chia left Wollongong Hospital and, despite an active recruitment campaign by the Illawarra Shoalhaven Local Health District (ISLHD), no replacement has been found.
ISLHD acting director clinical operations Suzanne Harris said the recruitment of a specialist paediatric surgeon to work from Wollongong Hospital had been a "challenge", given a national shortage of such specialists.
NSW Ministry of Health figures show that in 2010, there were 28 paediatric surgeons working in NSW with 29 per cent of those intending to retire within 10 years.
Paediatric surgeons are located mainly in metropolitan Sydney and the Hunter New England Local Health District with limited numbers in rural and regional health districts.
The loss of a surgeon at Wollongong Hospital means some children are forced to travel to Sydney for a range of common procedures, such as hernia repair.
Other common paediatric procedures - such as the removal of tonsils and adenoids - can be carried out at Wollongong, although more complex surgeries are referred to Sydney children's hospitals.
"General and specialty surgeons [such as ENT and orthopaedics] that operate on both adult and children currently perform surgery on children in the [district]," Ms Harris said.
"Some children with more complex conditions are referred to the Sydney Children's Hospital Network for more specialised surgeries.
"A recent review of paediatric surgical cases showed that more than 90 per cent of the children referred to Sydney would have needed transfer regardless of the availability of a specialist paediatric surgeon at Wollongong."
Deborah Bailey, the president of the ANZ Association of Paediatric Surgeons, said the high levels of skill and training required had contributed to the current staffing shortage.
"Operating on tiny babies and children is very complex, and there needs to be specialist anaesthetists and equipment available to support the paediatric surgeon, which is why it is rare for them to be outside children's hospitals," Ms Bailey said.
"So it may not be that attractive for a paediatric surgeon with seven years' training to go to Wollongong where they may only be able to perform fairly minor surgeries and not have a full workload.
"However, because we know this is a problem in regional areas, we are trying to get the government to pay for outreach services - so that paediatric surgeons and associated specialists can travel to large regional areas like Wollongong and provide their services to families where they live, instead of them having to travel."
Ms Harris said the local health district was developing a plan for paediatric surgical services at Wollongong Hospital, guided by a new statewide surgery framework.
"As the framework outlines, our district aims to achieve a suitable balance between providing safe and appropriate surgical services locally, and ensuring those cases which require more complex procedures have timely access to the expertise of dedicated children's hospitals and specialist surgeons."