NZ is currently 485 GPs short and “will struggle to train or bring in enough international medical graduates to meet this demand”, a briefing to Health Minister Dr Shane Reti has warned.
Doug Armstrong is a former Auckland District Health Board member and the former CEO of Unitec.
This latter proposal is opposed by the two existing medical schools, which have funded a report from PWC that unsurprisingly advocates increased funding to expand their offering.
As a former academic and eight-year member of the old Auckland District Health Board, I have long concluded radical reform of the training, recruitment, remuneration and funding the whole system of medical workforce formation is necessary.
The first thing to recognise is training to be a doctor or dentist is a great investment decision and career.
Incomes are substantial, with opportunities for self-employment and a worldwide market for employment. That is why demand from school leavers for places to enter the two medical schools is massively oversubscribed, despite high fees and capped intakes.
The Government funds universities on a per-student basis (some $50,000 per year for dental and medical students) via the Tertiary Education Commission - students pay the institutions a fee (some $16,000 per year for dental and medical education students).
This is often borrowed as a student loan, together with living expenses added, for the duration of the six-year programme. A significant percentage of any programme is clinical practice training that takes place mainly in hospitals, at some cost to them but under the supervision of the tertiary provider.
The PWC paper advocated a mere expansion of the status quo without examining a number of compelling and obvious alternatives.
The first of these is productivity. Why do all students have to do a preliminary year of health sciences before entry?
Many equivalent countries (whose graduates are recognized in NZ) allow highly qualified school leavers direct entry into medical school from Year 13 and they are able to qualify in five years - a huge saving for everyone, not to mention a 16% increase in output and lower cost/debt and income foregone by students.
Secondly, why can’t the savings made from the increased output be deployed to enable the creation of more supervised clinical places in the public sector to be provided - this was cited as being a problem by PWC. These places could be used to help with the workforce shortage with the adoption of a type of structured intern apprenticeship model.
Thirdly, there is the huge issue of increased migration of senior doctors and specialists from the public sector into private practice, where remuneration is greater and there are huge windfalls from private equity and corporate buyouts.
More than a third of adults are not getting the healthcare they need, a study by the senior doctors’ union has found.
This threatens the very concept of a viable and fair national public health system.
Typically, doctors have an involvement with both attendant perceptions of a conflict of interest and a shortage of hospital capacity. The savings involved by shortening the programmes should be used by Government to forgive student fee debt for each year of service in the NZ public sector.
I would also look at decreasing Government funding for these courses. This would result in increased student debt, but this is clearly offset by a course shortened by a year.
Requiring the existing medical schools and the Tertiary Education Commission (TEC) to facilitate the completion of dental and medical qualifications in five years, rather than six years for highly qualified school leavers.
Encouraging increased intake numbers into the existing medical schools for highly qualified school leavers by removing the places cap and through financial incentives, together with establishment of a third medical school to increase competition. This could include increased student fees offset by the shortening of the programmes.
Diverting funding from universities to the public health sector to enable the provision of increased clinical practice places and the establishment of an intern training programme to increase the sector’s workforce.
Forgiving a percentage of the fees component of student loans for each fulltime year of post-graduate public sector employment - perhaps 10% per annum.
Encouraging full-fee enrolments from overseas students and their future employment in the NZ workforce to be on a par with NZ graduates.
Whether the route and timelines to specialist registration are more onerous here than in our competitor countries.
Productivity and innovation gains in satisfying workforce needs in the health sector are just as important as those in any other sector and should be explored with an open mind.
Benchmarking against our nearest competitor, Australia, is vitally important.
