Professor Warwick Bagg, deputy dean, Auckland Medical School

The Government has rejected a proposal from the country’s two medical schools to train more doctors next year.

The schools have been asking for approval to increase places since National was in power before 2017.

Both National and Labour have said no to the requests.

The most recent rejection (this month)  has come after the Government released a health workforce plan released in August which committed to training more doctors.

It now appears the Government may be willing to increase places in 2024, but that means the extra doctors won’t be fully qualified until 2030.

The medical profession has argued for some time that the country faces a critical doctor shortage.

“We have widespread issues with short staffing and multiple rosters across the country where only half the required number of doctors are working,” said New Zealand Resident Doctors’ Association Secretary, Dr Deborah Powell.

“Fixing the medical workforce pipeline is going to require a massive bolstering in the number of medical students, and then a range of initiatives to keep doctors in New Zealand.”

On August 1, Health Minister Andrew Little announced a  “Government Plan to Boost Health Workers”, which included increasing the number of overseas-trained doctors able to work in New Zealand.

The only nod to training more New Zealand doctors was a plan to increase the number of doctors going into general practice, which would also “get more Maori and Pacific GPs”.

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But that was simply a plan to redirect graduates to General Practice rather than other specialities.

Since then, the two medical schools have been talking to the Government to try to persuade them to take more students next year, but POLITIK understands they have now been told that won’t happen.

Warwick Bagg, the deputy dean of the University of Auckland Medical School, told POLITIK the situation was becoming urgent.

We need to get that pipeline going, and given the long lead in times to get people into place, we needed to start yesterday,” he said.

In a statement to POLITIK, Little said: “We need to increase our domestic medical-training programme to make sure our medical workforce is sustainable and reflects the diversity of our communities.

There are several issues to work through, however, including the capacity to supervise training in hospitals and making sure we are training more people from Māori, Pacific rural and hard-to-staff communities.”

But Bagg argues that there are solutions to all of those issues.

He said his school was already going ahead with ensuring that 40 per cent of all students were Maori or Pasifika next year.

And he said there were answers to the hospitals’ capacity to supervise training once students have moved out of the University.

“The most recent advice from the government was that they wanted to ensure that there was enough clinical supervision at once,” he said.

“There’s still the last three years are largely an apprentice style learning, and they wanted to ensure there was adequate supervision.

“Our response to that is, well, they start off on our campus for a couple of years before they get into that position, and we’re on a constant engagement with the health services as to how we supervise the students.

“And that’s a constant engagement.

“So we think that can be addressed.”

Bagg said the Government also wanted more students from rural areas.

“Well, we’ve had a long-standing policy of doing that, and we’ve recently changed our definition to broaden the numbers of rural as opposed to just regional students who might come in,” he said.

“So we think we’ve addressed that.

“And then they raised attrition rates as a problem, which I don’t know why that’s a concern because the attrition is extremely low once you get into medicine.”

The whole issue originated in 2009 when the then National Government announced it would fund an additional 200 medical school places in Otago and Auckland.

But it only ever got to 175.

So, in 2017, when Labour was elected, the schools asked if they could have the missing 25 places approved; 18 for Auckland and seven for Otago.

The Ardern Government refused.

Now, 13 years after National said we needed 200 more doctors each year, New Zealand, with 16,908 doctors, is around 1300 behind the number of doctors in the United Kingdom (based on doctor-to-population ratios).

But currently, we graduate only 500 a year, and each year hundreds leave, including many of the overseas doctors who have come to New Zealand but never intended to stay for a long time.

He said that we’re importing about 1.7 doctors for every one that we graduate.

We know from data from the Medical Council that two years after being here, 60% of those overseas doctors have left,” said Bagg.

“They are simply here just for a short time and want to have a bit of overseas experience. They’re perfectly good clinicians; nothing wrong with them at all, but they have no knowledge of Aotearoa or Te Ao Maori or being culturally safe.”

That has particular implications for Maori and Pasifika trying to increase the numbers of Maori and Pacific doctors within the workforce because that has a cultural effect, he said.

“So our argument is that we think we need to grow the pipeline, which means that we need more students studying to become doctors, and so we’ve been making the case over several years to increase the number of funded places at both Otago and Auckland.”

It costs the Government about $40,000 per year to train a medical student, so the increased budget to admit an extra 50 would be around two million a year. That is loose change to any government.

The obstacle is, therefore, not likely to be financial but rather a blockage in the system somewhere, most likely at the former DHBs level.

Some Government sources suggest there might be concerns from the Medical Council about the quality of supervision of the doctors training in hospitals.

Bagg disputed this.

The Medical Council, in my experience, are quite receptive to looking at well-supervised ways of training people who are just emerging from medical school,” he said.

“So, for example, they created these community-based attachments, and they’ve worked very well across the country.

“We’ve met with them as recently as this year, and they are very keen to look at how we might expand this.

“I don’t think it’s helpful to blame the Medical Council.”

There is a hint of frustration with all of the arguments being put against expanding the medical school intake in the statement supplied to POLITIK by the Minister.

“I have directed the Ministry of Health, Te Whatu Ora – Health New Zealand and Te Aka Whai Ora – the Māori Health Authority to work with the Ministry of Education and the Tertiary Education Commission on options to increase medical school places,” it said.

But while that process works through, the doctor shortage continues and will grow worse, and the medical schools have to sit by impotently.

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