KEY POINTS:
If It wasn't for foreign-trained doctors, you might have a long wait to see a GP in Kawerau.
And in Wairoa. Both places have had near-complete reliance, according to the Medical Council, on doctors who received their first qualification overseas.
In Waikato and throughout the rural North Island you have a 50/50 chance of seeing a foreign-trained doctor. This is because New Zealand's doctor shortage means the country has the highest reliance on overseas-trained doctors, at 41 per cent, of any developed nation.
That's well ahead even of immigrant Meccas like Australia on 27 per cent and the United States on 25 per cent - and in New Zealand the figure has been rising steadily since the early 1990s.
However, there is pressure to cut this reliance on the world and to increase the numbers being trained in New Zealand.
Foreign-trained doctors occasionally grab the headlines accused of mistakes.
One was Czech-born specialist Roman Hasil, who is believed to have left the country. He resigned from Wanganui Hospital in March and is being investigated over failed sterilisation operations.
Another was British-trained Peter Fisher, found guilty of professional misconduct regarding mental health patient Mark Burton, who was discharged from Southland Hospital the day before he killed his mother in 2001.
Health and Disability Commissioner Ron Paterson has found a "slight" over-representation of overseas-trained doctors in breaches of the Code of Patients' Rights and his office is researching the matter.
Medical Council chairman Professor John Campbell balks at New Zealand's 41 per cent level of international medical graduates, as the council now calls them.
"It's a very risky figure, risky not so much because of the doctors themselves but because it shouldn't be at that level of dependence."
It is widely accepted that New Zealand's health system would collapse, especially in rural areas, without overseas-trained doctors. The Government increased the medical schools' intakes of state-funded students to 325 a year in 2004. The Auckland medical school's dean, Professor Iain Martin, said New Zealand needed 110 to 120 extra doctors a year for the next five years.
Heath Minister Pete Hodgson, who is expecting a report on the issue this month, agrees there should be an increase but is sceptical of Professor Martin's estimate.
The Government has already decided to increase the number of post-graduate GP training placements it funds from 69 to 104 a year. It will also spend around $900,000 a year on supervising 30 overseas-trained doctors annually during their hospital intern year. They would have had to sit the council's NZ-REX registration exam because they did not qualify to start practising immediately. Many have not worked in a comparable health system to New Zealand's.
Another training scheme is Ready for Work, a six-month "buddy" programme run by the Auckland District Health Board for overseas-trained doctors who are struggling after passing NZ-REX. It covers many skills including how to order medical tests, Maori culture, communication and patients' rights.
An evaluation of the scheme last year by former Medical Council chief executive Sue Ineson said there were "long-standing performance issues" with some international graduates, particularly those who had entered through the registration exam.
The course had enabled participants to assimilate faster and work more effectively than others who passed NZ-REX.
Mrs Ineson said the accents of some overseas-trained doctors made them hard to understand.
On her advice, the council - whose English language requirement is tougher than Britain's, Canada's and Australia's - resolved NZ-REX would test accent and pronunciation. Any marginal candidates must improve, "which may include speech therapy", before gaining even a provisional licence.
In hospital corridors too, there are concerns about the level of help for overseas-trained doctors.
"People are thrown in at the deep end without adequate support," said one senior doctor. "Not just immigrant doctors, but immigrant doctors are at high risk."
