MARK Stegmann doesn't go for walks, rarely has a beer and doesn't go to the movies.
Dr Stegmann is the only obstetrician-gynaecologist living in Wanganui and covering Wanganui Hospital and he knows that, more often than not, his phone will be ringing.
"I can't respond by saying to the hospital that I'll get back to them. I cannot do that. I have to be available immediately and be at the hospital within a few minutes to deal with a life and death situation," he said.
In an interview with the Chronicle this week, Dr Stegmann said the issue surrounding maternity services at the hospital was not about him. The problem is, he is at the centre of it.
He is supported by a colleague in Palmerston North and two locums. One of them finishes in April and the other in May. That's why the Whanganui and MidCentral DHBs are considering the regional women's health plan.
Dr Stegmann has had an association with Wanganui Hospital for the past 12 years and works excessively long hours. And when he is on call, he is expected to provide cover for acute conditions, 24-hours a day.
Working one-in-four means one day a week, and every fourth weekend means being on call for 24-hours during that day or weekend.
With the hospital reliant on locums (temporary doctors), Dr Stegmann is often left to pick up the follow-up work required when a locum is not available.
There is hope a UK specialist will join Wanganui but that is at least six months away.
Dr Stegmann said during his time in Wanganui, many different options had been considered to get specialists to the city and provide the service.
"Working closely with Palmerston North is not new. As far back as 2002, it has been discussed," he said.
"We struggle to recruit and medicine is constantly changing. This [proposal] is about a service being provided in a better way."
He told the the February 10 WDHB meeting that the proposal presented by the clinicians and management was looking to the future. "We've almost managed to block the holes in the service but this is not the safe way to manage things. The sooner we move to a sustainable model the better."
Dr Stegmann said that for two thirds of every week he is the O&G; specialist Wanganui Hospital relies on.
"But if I am sick then we have no service. That is the risk we're talking about. And on that basis it's becoming more and more difficult to keep the service."
He said sourcing O&G; staff was a massive problem, not just in provincial centres, such as Wanganui, but worldwide.
Compounding the issue is that hospitals were following the European model which demands O&Gs; work no more than 48-hour weeks. That was a long way short of the 72 hours, or more, that O&Gs; had been working.
It also means more O&Gs; are needed to provide cover and that exacerbates that shortage.
Dr Stegmann said money was an issue but he maintained it was not the major reason that would attract clinicians to Wanganui.
"We don't have the junior staff to support the specialists and to back them up and that is the major weakness and the thing that deters recruits."
"The problem in places like Wanganui is really about the numbers and the rosters," he said.
He said working at Wanganui Hospital meant O&Gs; had to be available "nearly all the time" and that was a "major problem".
"We've been at full strength briefly but for long periods it has meant working one day on in every three or sometimes every second day."
Dr Stegmann said O&Gs; were no longer trained to be generalists "but that's exactly the type of O&Gs; we want here".
He said New Zealand looked to the UK as a source of O&Gs; but those trained there expect they will work with junior staff on site (the junior staff were generally the first to be called before a specialist).
"They expect to day a maximum of a one-in-five on call roster."
He said specialists were not leaving for Australia just for the money. They were going because their were more people and much greater scope for their work.
He said trying to recruit staff had been "an all-consuming on-going battle" from the time he had arrived in Wanganui.
Dr Stegmann gets phone calls day and night, which means he has to be prepared to go all the time.
"I cannot go for a walk, I can't have a beer, I don't go to the movies.
"After a few months, it's okay but after a year, or longer, it does become harder."
Dr Stegmann said exacerbating the problem for Wanganui Hospital was that there was no contingency plan.
"We don't have a five-day plan let alone a five-year plan. We survive day to day, plugging gaps as, and when, we can," he said.