KEY POINTS:
You can barely pick up a newspaper lately without reading about major problems facing the medical workforce. The problems are ongoing, have been evident for several years and in some cases are worsening.
We know the problems and now it's time for action. The New Zealand Medical Association, whose members come from all disciplines within the medical profession and include specialists, general practitioners, doctors-in-training and medical students, believes that if we are to make progress, it is time for some far-reaching solutions to be implemented.
As a result of consistent pressure by us and other groups, the last few years have seen a flurry of official working parties and reports on this issue.
Key problems that have been identified are:
* An overall shortage of medical practitioners, evidenced by the use of expensive locums and reliance on overseas-trained doctors. This will get worse as the population ages and competition for practitioners increases in the international market.
* A maldistribution of the available medical workforce, with rural and non-metropolitan areas finding it increasingly difficult to recruit and retain doctors.
More specifically: too many medical graduates choose to work overseas (26 per cent have left by the end of their second post-graduate year). And locums, both senior and junior doctors, have been estimated to cost the country $100 million annually.
New Zealand is relying too heavily on overseas-trained doctors - although we must acknowledge that our health system would grind to a halt without them and at an individual level, they make an invaluable contribution. Overseas-trained doctors now comprise 41 per cent of our workforce and more than 60 per cent in rural areas.
In the year to June 20, 2006, the Medical Council of New Zealand reported registering 315 doctors trained in New Zealand and 1270 who trained overseas (although they do not all plan to stay here).
Specialties such as general practice, pathology, psychiatry, obstetrics and gynaecology) are suffering from severe shortages and the situation is likely to worsen.
There's no doubt well-trained doctors are an international commodity and health is a global market. If doctors don't want to work here, they can easily gain work overseas.
Why do we acknowledge the reality of the international market in all employment areas except health?
Have we reached crisis point? The online dictionary Encarta defines crisis as "a dangerous or worrying time: a situation or period in which things are very uncertain, difficult, or painful, especially a time when action must be taken to avoid complete disaster or breakdown". The NZ Medical Association believes we have a crisis.
We have long called for successive governments to develop a comprehensive workforce strategy which addresses the critical issues that have lead to the current medical workforce crisis. Only now is there some evidence that this may be happening, albeit slowly. Firstly, New Zealand must move rapidly towards sustainability of its workforce. It is clear we are training too few medical students but not clear how many we need to train. Australia has taken the bold move of doubling its numbers of medical students. This is not cheap and has led to a number of downstream effects, such as a lack of training places once graduated. However, there is time for this to be sorted by 2012 when the tsunami of graduates arrives.
This week, the Government announced that the number of medical students being trained annually would increase from next year by 40 to a total 365. This is a significant increase and very welcome. However, if New Zealand is registering 1270 doctors from overseas (as it did last year), then doubling the student intake here would not seem radical.
It is not just New Zealand which is facing problems with its medical workforce. Australia, Great Britain, Canada and the United States have all developed long-term strategies to resolve their workforce problems, while New Zealand has not. Pay rates and terms and conditions of employment offered in New Zealand can't match what is being offered elsewhere and our highly-touted lifestyle conditions no longer bridge the salary gap.
Indeed, the frequently hostile working environment in New Zealand District Health Boards further discourages retention in New Zealand. That is why it is imperative that the impasse between senior doctors and DHBs be resolved quickly. Without a swift resolution, the ongoing industrial situation will cause major problems for patients and the medical workforce, current and future.
Protracted industrial negotiations will only worsen existing problems. The NZMA has called on Health Minister Pete Hodgson to step in and help sort this out.
There are many other things that can be done to promote the retention of New Zealand doctors. There is no economic sense in training doctors to work in New Zealand conditions and then see many of them leave, only to be replaced with expensive locums.
The Government has been sent some clear messages about what is happening, what needs to be done, and what the consequences will be if nothing (or not enough) is done.
It is showing some commitment to progressing solutions to the medical workforce deficiencies but bureaucracy has a habit of slowing even the best of intentions.
It's now time to take some confident action in a comprehensive strategic way to ensure the future of the needed medical workforce. The debate is over - the New Zealand public needs to see decisive solutions.
* Dr Peter Foley is chairman of the New Zealand Medical Association.
