Palmerston North Hospital has lost the last permanent doctor in its gastroenterology service, leaving the wider Manawatū and Whanganui region without a single full-time specialist to look after thousands of people with serious digestive and bowel conditions.
Dr James Irwin, who had been the only permanent gastroenterologist still standing, finished up on 19 June after more than a decade at the hospital and 26 years working for the public health system. His departure ends a slow collapse that has played out over the past three years, with a service once funded for just under six full-time specialists now relying entirely on temporary locum and visiting doctors.
Speaking to 1News, Irwin described how the team had unravelled. “There were six of us. Then we had some illness, and a period of time with an inability to recruit,” he said. As colleagues left, the remaining doctors absorbed more and more of the workload. “Normally in a department, you share that amongst your group, but as people leave, you’re left with it. Yeah, so it’s hard.”
He did not hide how difficult the decision had been. “I feel really guilty about it, and it’s really sad,” he said. Irwin was clear that the answer was never about throwing money at recruitment alone. “Retention’s the way to fix it, and we unfortunately were not able to do that.”
Three years ago the service had seven specialists. By the start of this year it was down to a handful of permanent staff, and for months Irwin was carrying much of the load on his own. He has spoken before about what that meant for patients across the region, telling RNZ that “the postcode lottery has worsened and deepened” over the past five years, with where you live increasingly deciding how quickly you can see a specialist.
Gastroenterologists diagnose and treat conditions of the gut, liver and bowel. They run the colonoscopies and endoscopies that sit at the heart of the national bowel screening programme, the camera tests that catch bowel cancer early when it is far more treatable. Without a stable local team, those procedures lean on visiting doctors who fly in and out, which makes it harder for patients with long-term conditions to see the same person twice.
Irwin argued the problem is bigger than one hospital and pointed to a wider failure to keep doctors trained in New Zealand working here. “Te Whatu Ora is responsible for providing healthcare to all New Zealanders, and that includes people in the provinces,” he said. “Our health workforce is reliant on many overseas trained people, and we’re very grateful for the service they provide. But we also need New Zealand trained doctors to work in our hospitals.”
Health New Zealand Te Whatu Ora says the service has not stopped. Chris Lowry, the executive regional director for the central region, told RNZ the agency wanted to calm fears that care was disappearing. “We want to reassure our community that essential gastroenterology services are continuing,” he said. “We acknowledge this has been a challenging period, and we are focused on strengthening the service and improving access as quickly as possible.”
The agency has recruited a new specialist from overseas who is expected to start in September, and says other candidates are working their way through the hiring process. It has put an onboarding allowance and a 12-month completion allowance on the table to try to draw clinicians to Palmerston North. Even so, the hospital will keep leaning on locum and visiting staff while it tries to fill the remaining gaps, and a single new appointment falls well short of the six the service is funded for.
Local frustration has been building for months. Tangi Utikere, the Labour MP for Palmerston North, has been blunt about the urgency. “It needs to be sorted and it needs to be sorted, now,” he told RNZ.
Others have framed the stakes in starker terms. Dr Thomas Carter, an emergency medicine specialist and president of the local branch of the Association of Salaried Medical Specialists, warned that a region without ready access to gut and bowel care will see real harm. “If there is not someone available locally, then some of the patients are going to perish,” he said. Malcolm Mulholland, who chairs the patient advocacy group Patient Voice Aotearoa, put it just as plainly, saying that without the service “people will die”.
Patients themselves are worried less about the headlines and more about continuity. One long-term patient, 37-year-old Julia Russell, told RNZ she was anxious about losing the consistency of seeing a permanent specialist who knows her history, rather than a rotating cast of locums.
The departure of a hospital’s last specialist in an entire field is unusual, and it has touched a nerve well beyond Palmerston North because the pattern is familiar. Provincial hospitals across the country have struggled to recruit and hold onto senior doctors, with smaller centres often the first to feel the squeeze when a service is short staffed. Gastroenterology is one of several specialties where New Zealand has long relied on overseas-trained doctors to plug gaps that home-grown training has not filled.
Health NZ is due to front the community directly, with a public meeting planned for Monday evening at the Massey University Sports and Events Centre on Albany Drive in Palmerston North, doors opening at 5pm for a 5.30pm start. Residents are expected to press officials on how long the region will go without a permanent team, and what happens to bowel screening and routine procedures in the meantime.
For Irwin, the worry is what his leaving says about the future of provincial medicine. He has made clear he does not see the situation turning around any time soon, and that after 26 years in the public system he needed to move somewhere the workload was sustainable. The challenge he leaves behind is whether Palmerston North can rebuild a team from scratch, or whether the region settles into a long stretch of fly-in, fly-out care.
What do you think Health New Zealand should do to keep specialists in provincial hospitals? Have you faced long waits for gut or bowel care in your part of the country? Share your experience in the comments below.
This article was written by AI, briefed to report the facts, hopefully without some of the bias people bring to the job 🙂
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