The New Zealand well being system is at present within the throes of its greatest reorganisation in additional than 20 years. The purpose is to offer extra effectivity and fairness.
But whereas it’s acknowledged New Zealand has under-invested in well being infrastructure, extra damaging has been the under-investment in individuals.
This lack of planning for the long run well being workforce is immediately liable for the staffing shortages now being skilled. These shortages are being patched up with short-term options similar to attracting overseas-trained well being staff with guarantees of fast pathways to citizenship.
So in addition to structural reform of the well being providers, the imaginative and prescient for these providers and subsequent workforce calls for must be articulated. Ideally this would come with a price range that invests in coaching extra – and extra various – New Zealand docs.
We know the demand for extra docs is relentless – fuelled by a rising and ageing inhabitants. At the identical time, we now have an ageing medical workforce, with many docs planning to retire within the subsequent decade.
There has been a 40% enhance within the variety of docs registered with the Medical Council over the previous decade, from 13,880 in 2012 to 19,623 in 2023 – a year-on-year enhance of three%.
To maintain this modest development every year, we might want to enhance the whole medical workforce by 590 yearly. We can even want an extra 300 docs a yr to interchange those that are retiring or leaving to work in Australia and elsewhere.
Critically understaffed and with Omicron looming, why is not NZ using extra of its foreign-trained docs?
Yet we at present solely have two medical colleges coaching 550 docs a yr between them. So we proceed to depend on importing docs from different international locations.
Out of the OECD, New Zealand has the very best dependency on overseas-trained docs, with 42% of the workforce being worldwide medical graduates (IMGs).
The areas with the bottom percentages of IMGs are Auckland (31%), Capital & Coast (34%), and Canterbury (36%). But this could climb to 60% in lots of rural areas. Last yr, 1,232 IMGs had been registered to observe right here, reflecting the excessive demand for docs not being met via native coaching and retention.
Paradoxically, certainly one of Health New Zealand’s targets is to extend the variety of Māori and Pacific docs, which is difficult to do after we depend on importing twice as many docs as we practice.
Our lacking GPs
Doctor shortages aren’t evenly unfold. There are specific issues within the much less rich areas, and particularly specialities similar to common observe. GPs are the spine of the well being system, with 90% of well being consultations occurring in major care.
Yet whereas we now have elevated the variety of docs by 5,000 over the previous ten years, the variety of GPs has solely elevated by 260. This means we now have GP shortages, leading to growing demand on hospitals, growing ready occasions within the emergency departments, and a rising downside of late prognosis and poorer well being outcomes.
The Royal New Zealand College of General Practitioners has known as for these shortages to be urgently addressed by growing the variety of junior docs coaching typically observe to 300 per yr. This is hardly potential with solely two current medical colleges – it might imply greater than half their whole output of graduates going into the GP coaching programme.
New Zealand’s well being restructure is doomed to fall brief except its funding mannequin is tackled first
Currently, simply 25% of the 550 medical college graduates (130-140 docs a yr) select to enter common observe. To obtain a aim of 300 we would want to double the variety of docs coaching or take a considerable variety of junior docs out of the opposite speciality coaching schemes.
There are geographical variations in the place docs are working, too. New Zealand graduates have a tendency to decide on to observe within the main centres the place they’ve educated, whereas excessive wants communities and regional centres need to rely much more closely on attracting IMGs.
Thus the Te Manawa Taki area – serving a predominantly rural inhabitants of over one million individuals throughout the central North Island, together with 25% Maori – has 7% fewer docs than the opposite areas (or 265 fewer docs than could be anticipated).
Investing in coaching
The United Kingdom not too long ago opened 5 new medical colleges, whereas Canada is ready to open three. In each international locations, analysis confirmed docs tended to remain and work within the space the place they educated. The new medical colleges are situated in areas with excessive wants and recruitment difficulties.
There is little doubt New Zealand needs to be following swimsuit.
No one is mourning the tip of district well being boards, however rebuilding belief within the system will not be simple
The New Zealand Resident Doctors’ Association is asking for one more 200 medical college students a yr to be educated. This needs to be simply the beginning, with ongoing commitments to extend pupil numbers according to the rising medical workforce.
But merely growing the variety of college students going to Auckland and Otago medical colleges won’t work. We can not count on totally different well being workforce outcomes by doing the identical factor repeatedly.
We want extra docs in coaching, we have to appeal to college students from a wider vary of backgrounds, we have to place these college students within the areas they’re wanted, and we want a brand new curriculum that can put together for a workforce according to the long run calls for of the New Zealand well being system.
That can solely be achieved with a brand new and extra socially accountable medical college, and vital funding. It is alleged one of the best time to plant a tree is 20 years in the past. The subsequent finest time is now.
Ross Lawrenson works for the University of Waikato which has a strategic aim of getting a medical college. He has obtained grants previously from Health Workforce New Zealand for coaching docs and researching workforce wants.
He is a member of the National celebration.
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