University of Otago Medical School

It has taken an election campaign to see both major parties propose solutions to one of the country’s most serious challenges- finding enough doctors.

For at least the past six years, both National and Labour have stalled on training more doctors.

Now, we need at least an extra 1700.

But yesterday, Health Minister Ayesha Verrall doubled down on doctor training and announced that the Labour government would train another 95 medical students a year. She announced that that would be on top of an extra 50 in June.

All the extra students could start next year.

But Verrall’s latest move was actually in her capacity as Labour’s spokesperson on health and is a Labour election manifesto promise, not a Government policy.

It would only happen if Labour were to form the next government, which at the moment is looking unlikely.

Verrall’s move was obviously meant to counter National, who also have a campaign promise to build a third medical school at the University of Waikato, which would not open until 2027.

In the meantime, National National would train an additional 50 doctors a year but not starting until 2025.

In July, when National leader Christopher Luxon unveiled the proposal for a third medical school, he said it would train another 120 doctors a year.

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But in July, Te Whatu Ora unveiled its “Health Workforce Plan”, which showed that currently, we are short of 1700 doctors, and by 2032, we would need over and above that another 3400 doctors.

If Labour’s proposal from yesterday were to be introduced, then the Auckland and Otago medical schools would be producing 684 doctors a year by 2032.

If National were to become the government and it did not follow up on Labour’s announcement yesterday, then the two existing medical schools plus Waikato would be producing 759 doctors a year — 25 more per year than under Labour’s plan.

But to build a medical school in Hamilton would require $380 million in capital expenditure and another $20 million in set-up costs.

Luxon’s argument for the school began with his recognition that  New Zealand did not train enough doctors to meet the demands of a growing and ageing population or to replace the retiring health workforce.

“This medical school should have been started five years ago as the previous National Government planned,” he said, announcing the proposal back in July.

“Labour cancelled it in 2018, and their short-sightedness means we will have to continue to rely heavily on immigration to increase our doctor numbers in the short term.”

There is no doubt Labour was reluctant to train more doctors. But so was National.

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.

Another proposal last year to increase numbers this year was rejected, and instead, then-Health Minister Andrew Little said the increase would have to be in 2024.

That was what Verrall announced in June.

“We are growing the number of doctors trained in New Zealand to help meet the needs of our population and ensure health equity across the country,” she said.

“We want to train and retain as many local health workers as possible,” Dr Ayesha Verrall said.

“We have always been reliant on overseas-trained doctors, and we recognise the skills and knowledge the international workforce brings to our workforce.

“However, to address inequities in the system and build a sustainable workforce, we must grow and invest in our domestic doctors, especially when there is global competition for internationally trained doctors. 

“Training more medical students will help us grow our domestic workforce over time, ensuring we can provide sustainable public health care.”

But the question remains: Why has the government been so slow to increase medical student numbers?

The Prime Minister yesterday tried to blame the previous National government.

“We need more doctors given the decades of underfunding of our health system, and this record boost to our doctor training will make a difference for years to come,” he said when he announced the additional 95.

The supporters of the Waikato Medical School have argued for it on the basis that it would produce more rural doctors.

But the deputy Dean of the Auckland Medical School, Warwick Bagg, told POLITIK that both Auckland and Otago were already providing specific training for rural doctors.

Ironically, many of those students are located in Hamilton.

“We have a network of training sites that stretches from Whakatane across to Taranaki t all the way up to Kaitaia, including about 150 or 160 students a year every year in Hamilton,” he said.

So we have an extensive training network, and we will look to be building capacity with Te Whatu Ora.”

Faculty of Medical and Health Sciences Dean, Professor John Fraser said the University had been part of a proposal to form a  National Interprofessional School of Rural Health involving the universities of Auckland, Otago and AUT with the Royal NZ College of General Practitioners and the Rural GP Network.  

Otago selects at least 50 students each year on the basis of their rural background.

Bagg said the abolition of the District Health Boards and the advent of Te Whatu Ora had helped deal with one of the major challenges facing the medical schools: finding training places for their students.

 “With the Whatu Ora being a national body, we now have this ability to say we don’t have to negotiate with every DHB about taking extra students,” he told POLITIK.

“I have the Director of Health Workforce from Te Whatu Ora telling me how many more can you take, and please fill up every slot you can.

“So we now have a national coordination around this.

“This is a game changer for us.”

It says a lot about how New Zealand makes policy that it took an election campaign for these issues, which date back at least six years, to begin to be resolved.