Practising Radiation Oncology in Dunedin, New Zealand

An Interview with Dr Tivanka Senanayake

What brought you to regional practice?

Opportunity and timing. I had undertaken all of my radiation oncology training in Wellington, worked as a consultant for a year or so there, and spent a year in Princess Margaret Hospital in Toronto, Canada. I was ready to find a position that would suit my young family. There were no consultant posts available at Wellington and I was looking into options in Ireland and Australia when both a colleague and my recruitment agency let me know of a locum job at Dunedin Hospital. I had very little knowledge of the set-up at the department but the short-term nature of the post appeared to be a good way of getting a feel for the hospital and the city. I must say, I never thought I would be staying for long, but here I still am two and a half years later… and I like it!

Why practise outside of metropolitan centres?

Practising in a regional setting has a number of nuances. The downsides, for example, might be that simple processes that you may have taken for granted (such as using standardised protocols) may not be established. In my opinion, however, the benefits can be great. You have an opportunity to truly play a part in shaping the direction of the department that you just wouldn’t have in a larger metropolitan setting. New processes can be decided by the few people inside one room rather than a number of committees having to sign off. New techniques can be discussed and fast tracked. I have felt particularly valued and appreciated for my role. There is no space for a lack of enthusiasm and a there is a spirit to make things work which means that you are surrounded by passionate and driven people.

Are there limitations or challenges in regional practice?

Yes, the infrastructure you expect may not be present. That may be a simple health pathway, resources for treatment or investigation, or some supports for patients. One of the biggest challenges has been caring for patients from small distant communities. At Dunedin, we cover one of the biggest geographical catchment areas in New Zealand with patients from very small towns. Many lack specialist care in their region and this can influence decision-making on management. I would also say that the draw for trainees and qualified radiation oncologists is not as great as compared to bigger centres and we have had a particular problem with staffing.

What has been the overall effect of the pandemic on the regional experience? Have there been any unexpected upsides? Issues to be confronted now?

Like most departments, we have not been unaffected. When all non-urgent treatment was delayed during the lockdown period our waiting lists were naturally impacted and they have grown, which is not ideal. We continue to address this through staff taking on additional work, a recruitment drive, and outsourcing treatment to other centres. Upsides have included being able to do some work from home, for example, admin or treatment planning which is nice. Being in a small city like Dunedin means that even if I’m working from home I can be in at the department within ten minutes if necessary. The flexibility in this regard has been good.

How do you see the next 10 years for the specialty of radiation oncology in the region?

I see us as being a growing specialty and department. Naturally, demand increases as the population grows and ages, and our population is definitely growing. We are actively recruiting to increase staff numbers in the department to service that demand.

We are already the only centre in the country licenced for stereotactic radiosurgery, which is a treatment modality we plan to continue to offer and grow.

Within the last two years we have increased our funding for registrar numbers from one to four, and hope that we become an important training centre for future radiation oncologists. We also look forward to collaborating with Christchurch in moving towards a single South Island cancer service as per the national restructuring of the health service.

What needs to change for patients?

One of the main challenges for regional centres like mine is recruitment and retention of permanent staff. When this is an issue, we are understaffed which has significant knock-on effects on patients. Waiting lists are long, and some patients end up with negative impact on their disease progression. Some patients also face travelling long distance to other centres if we outsource treatment to reduce waiting lists. Ideally we would have a fully staffed department so that waiting lists are not an issue, patients get the treatment they need in a timely manner and in the department and with the clinical team they know.

What needs to change for clinicians?

A similar issue to above—we need more of the whole team; doctors, radiation therapists, physicists, nurses, allied health and admin staff! We are a regional department but we have a large catchment area similar in size to some of the city departments in New Zealand. Being short-staffed means we are stretched thin. It is frustrating not being able to deliver ideal treatment or timing for our patients due to staff shortages.

We do, however, come together to support each other and being a small team means we work hard to optimise the work we do for our patients. Management has been working with the clinical team to improve things in this regard and we all now share an aligned vision of how we want to grow and develop the department.

What training pathways are available in your region?

In the radiation oncology department in Dunedin we currently have two Part 1 registrars, but will have places for two more from February 2022 taking our registrar number to four. Our aim is that over the next couple of years overall registrar numbers will increase and that we will also be able to accommodate advanced trainees.

Is there a particular story you have encountered in regional practice that stays with you?

One of my colleagues was on a flight to a satellite clinic on a small 10-seater aeroplane. In poor weather these flights can be quite scary. On this one occasion the door opened mid-flight and my colleague had to hold it closed until they landed. Thankfully I did not have this experience when on these flights, but I have now decided to drive to satellite clinics…I am unsure which mode of transport is more dangerous.

What would you say to someone considering leaving the city behind?

Having lived and worked in larger city departments in the past, I know the thought of moving to somewhere relatively small may not always be enticing. After the past two and a half years in Dunedin, however, I must say I really enjoy it here. Being part of a small department is lovely from a team and relationship perspective, and it feels like we have real scope and prospect for development of our service. On a general life front, being in a smaller city is great for work-life balance because commutes are short, and overall I can be anywhere I need to be in the city with family in 10−15 minutes. Dunedin is a really friendly city, and my family has settled well here and schools are generally of a high standard. Add to that the real beauty of the surrounding countryside and coast, and proximity to central Otago, it offers something for everyone, no matter what their interests. So, come and give it a try!