Policy announcements have included extra medical school places and reinstatement of health targets. Photo / 123rf
Policy announcements have included extra medical school places and reinstatement of health targets. Photo / 123rf
OPINION
With the election campaign period under way, it was inevitable health and health policy would come under the spotlight. Sure enough, it’s recently been rated the third top issue in yet another poll, close on the heels of the economy and cost of living.
Policy announcements have included extramedical school places and reinstatement of health targets. What is not being considered politically is how we are training our already tired, undervalued medical resident doctor workforce. So little of the political health debate is informed by actual clinicians and frontline facts.
As a resident doctor who works in our hospital system, I’ve found watching how various parties are looking to scratch the health issue itch fascinating, and as a Specialty Trainees of New Zealand executive member who has taken part in complex, multifaceted workforce planning discussions with Te Whatu Ora Health New Zealand and the Health Minister, I can’t help but feel frustrated.
It’s obvious neither major party has made a full commitment to resident doctors. It’s also obvious there is a real tension between the complexities of the health system and effective health policy and the needs of political parties to pitch policies as simple bite-sized messages. I think that does New Zealanders and doctors a huge disservice.
As part of a comprehensive plan to address the wider medical workforce issues, more students is a good idea - we need to grow our workforce. However, as a stand-alone policy, it’s akin to pouring more water into a bucket full of holes. If we can’t care for and adequately train our already-graduated workforce, then there is no point committing to producing more medical school places.
A large part of why New Zealand’s health system is failing to provide enough training to resident doctors is the outsourcing of public healthcare service into private. This is happening at an astounding rate, with many types of publicly-funded private surgery doubling or tripling in recent years. While this might plug gaps in present surgery targets, resident doctors can’t train in private surgeries. Less training means fewer senior doctors coming through.
Right now, outsourcing to private is coming in response to understaffed theatres, lack of theatre capacity and ballooning wait lists. Add to that the increased number of New Zealanders taking up private health insurance and you have the recipe for a real workforce training crisis.
The majority of new doctors in our hospital system - myself included - are there because we are training to specialise. In the meantime, we are the workforce that puts in the majority of doctors’ hours in our hospitals, and help keep the wheels turning. We keep the ED open, we manage patients’ day-to-day care. And we also assist and perform surgery. Or rather, we try to, because that time in the operating theatre that is so critical to us becoming good ENT surgeons, or good orthopaedic surgeons, or - in my case - becoming a good obstetrician/gynaecologist, is being diminished.
Fewer training opportunities means fewer senior doctors coming through, which means fewer training opportunities. It’s a vicious cycle. It also sets up another vicious cycle: that of more senior doctors being pulled into private practice as an alternative to burning out in this stretched public system. That public system pressure is a key driver in the current senior doctor strikes. We support them.
Jordan Tewhaiti-Smith
Add to that an ageing workforce, the increased incentives for trainee doctors to leave New Zealand such as greater training opportunities and much better pay, and it’s not hard to see how adding more medical students doesn’t really feel like the whole answer.
The decline in training opportunities has many resident doctors looking across the ditch where time in the theatre is much easier to get. Added to the pay problems - resident doctors have seen their hourly rates decrease in real terms by 17 per cent in the past decade, while their worked hours have increased nearly 10 per cent over the same time - and you can see why many of us are starting to look elsewhere.
The bigger question here is, how do you talk about health meaningfully in a political context? The sophistication of the public debate about health and the column inches it gets pales in comparison with the public debate about the economy. I can’t help thinking that’s part of the reason we’ve let healthcare get run down over so many years. It’s time for a more thoughtful approach.
