The Government has approved more migrant doctors to come into New Zealand, but while it did that, it has been sitting on its hands about training any more New Zealand doctors.
Instead, it continues to allow the training of overseas doctors in spaces that could be taken up by New Zealanders.
There is now a crisis among rural GPs, and the University of Auckland Medical School has proposed ending its fee-paying overseas students and replacing them with New Zealand students.
That would create 30 new places in the school a year.
But it would require Government funding from Vote Health transmitted to the Tertiary Education Commission to replace the private funding coming from the overseas students.
Despite various submissions to Health Minister Andrew Little, he has yet to agree with the proposal.
In a statement last night, Little said: “
“The number of medical student placements is not a sole matter for Te Whatu Ora – Health New Zealand, it also involves the Ministry of Education and the tertiary institutions.
“A decision was made to not increase the number of med school positions for 2023.”
But this is as rural New Zealand finds its doctors are either retiring or leaving.
Kyle Eggleton, the Associate Dean (Rural) at the University of Auckland Medical School can tick off the problem areas; Kaitaia, the Hokianga, Dargaville, Whakatane, Toktora, rural Taranaki and so on.
“We’ve got this massive workforce crisis that’s occurred, and it’s been heralded for years,” he told POLITIK.
“We’ve known that it was going to occur, but unfortunately, there hasn’t been any workforce strategy or development that’s been undertaken to address the problem.
“So now we’re left with this problem, which is going to impact on mortality and morbidity as people aren’t able to access health care.”
The immediate answer from the Government has been to open up the Green list to general practitioners.
But this is, at best, a short-term solution.
Medical Council research shows that overseas doctors are unlikely to stay in New Zealand for long.
The Council found that doctors from Africa, the Middle East, and Asia were most likely to stay.
We retain over three-quarters of doctors from these regions for one year and about 50 per cent for a further four years.
Over half of doctors from Africa and the Middle East are still in New Zealand up to seven years after they initially registered.
Doctors from North America were least likely to stay in New Zealand, followed by Oceania (mainly doctors from Australia and the Pacific), the United Kingdom (UK), and Europe.
Only 42.0 per cent of doctors from North America were retained one year after initial registration, dropping further to 23.3 per cent in the second year.
While around 62.7 per cent of doctors from the UK were retained after one year, this then dropped to just under 34.8 per cent in the second year.
“This suggests that doctors from the United Kingdom and North America are more likely to come to work in New Zealand temporarily or for short periods only (e.g., a working holiday),” the report said.
“Doctors from Africa, the Middle East and Asia are more likely to relocate to New Zealand permanently.”
But Dr Eggleton told POLITIK recruiting doctors from those countries raised ethical questions.
“There’s an ethical dilemma there where you’re taking those graduates away from other countries, which are also facing workforce shortages,” he said.
“And there’s the ethical dilemma of taking doctors from developing countries where their skills are required.”
Eggleton said the University was currently training 30 overseas doctors who would not necessarily stay in the country once they had completed their training.
“International graduates are funding their own way, and we can’t increase our domestic intake without having some funding to replace what international graduates are giving the university,” he said.
But the funding is a complex process. The money starts within the Ministry of Health and then is passed on to the Tertiary Education Commission, which in turn passes it on to the University.
To deal with the immediate problem of rural GPs, the Rural Health Network — Hauora Taiwhenua, with the support of the Royal College of General Practitioners and both medical schools, is proposing a pilot scheme that would offer up to 50 placements for training rural doctors in their local area.
But this doesn’t increase the number of New Zealand medical graduates; it simply shuffles those already in the system around.
Eggleton believes the rural health crisis has much wider implications.
“I think that the way in which Te Whatu Ora is looking at the health workforce crisis is prioritising other professions,” he said.
“So they’ve increased the number of nursing students and pharmacy students.
“The emphasis in those areas needs to be increased as well because we’re facing a rural nursing workforce crisis.
“In fact, basically every professional group is a crisis in rural areas.
Dr Eggleton also practices in the Hokianga as a GP and recently had an acute case that needed to go to Whangarei Hospital urgently, but the Northland helicopter was not available, so he had to use an ambulance which took three hours to get to the city.
He said this is this was sort of thing that made rural practice difficult.
“If you’ve got a limited rural workforce, that workforce is stressed and they need, as much support as they can possibly get, dealing with these quite acute serious cases that arise and you don’t have an infrastructure around to support them,” he said.
He said it impacts on the health outcomes for rural people.
“I see rural health as the canary in the coal mine; they are so much harder to staff, so they start dropping off.
“Then you start to see the crisis spreading into urban areas.
“So what’s happening now in rural areas will spread to urban areas as well.”