Doctors trained in general practice and in specialties are significant in the medical care of Zealanders; however New Zealand is on the brink of medical workforce shortage, especially on doctors that have vocational training or specialty. Maori and Pacific doctors who could augment the low supply of doctors cannot contribute as they significantly remain to be under-represented.
This article discusses the demographics of New Zealand doctors, the participation and involvement of Maori doctors, the problem in retaining New Zealand’s specialty doctors, and the government’s role in the medical field.
Demographics; a Look into New Zealand’s Doctors
A: Size of the Workforce
According on the Medical Council’sregistration data, the number of active doctors in New Zealand has increased by 2.5 percent,from 14,333 in 2011 to 14,686 in 2012. Urban areas have a higher concentration of doctors, and GPs compared with rural areas where population density is lower. Main urban areas have 342 doctors per 100,000 residents compared with 140 doctors per 100,000 in rural areas.
B: Age Distribution
The 2012 survey of Medical Council of New Zealand indicated that in earlier years (2000–2003), the largest group of doctors (almost 20 percent) was in the 40–44 year age group. By 2009, the largest group of doctors is aged 45–49 and in 2012, the largest group is doctors aged 50–54. Female doctors are more likely to be younger than male doctors: 45 percent of females in the workforce are under the age of 40, compared to 28 percent of males. For the over 60 age group, females account only for 5 percent compared to 19 percent of males. This reflects that although male doctors have historically outnumbered female doctors, and still make up 59 percent of the medical workforce, this gap is decreasing. Females now outnumber males among new doctors.
C: Average hours worked
According to the Medical Council of New Zealand, the average number of hours worked for all active doctors is 43.9 percent per week with doctors aged in their twenties working the most hours each week on average. For both males and females, the trend is for the average number of hours to decrease between the ages 30 and 44, and then increase slightly, before decreasing again after the age of 60.
Based on Head Medical.Com, doctors in New Zealand earn between NZ$150,000 to 185,000 on average depending on their experience, and the number of hours they work per week.
Specialty “Breakdown”: Struggling to Get Hold of Specialists
Based on the website of New Zealand Now, the country needs 380 specialists every year to meet its OECD average by 2012. This statement is echoed in the 2014 study of the Association of Salaried Medical Specialists (ASMS), stating that “specialist workforce is a ‘leaking bucket”. This is because of several factors noted by ASMS such as:
A. The changing demographics of the medical workforce where a significant portion of the specialist working force is approaching retirement age. The unpublished Medical Council of New Zealand (MCNZ) workforce survey data indicated that based the on recent trends, about 19 percent of the specialist workforce will be lost within five years due to retirement.
B. The younger generation doctors migrate to other countries in search of a better life-work balance. On average, more than 10 percent of medical school graduates are not registering after their final class year. Of those who do register, about 37 percent are no longer practicing in New Zealand a decade later, when they usually are in training to become a specialist or a general practitioner. Of the medical graduates who do gain vocational registration, about 10 to 12 percent are lost and no longer practicing in New Zealand.
Maori and Pacific Doctors: Not Represented and Under-represented
Producing a medical workforce that is reflective of the social and cultural diversity of New Zealand is essential. For several years, Maori and Pacific people have signaled a need for more Maori and Pacific medical practitioners. It is considered that a more culturally appropriate service is likely available from someone who has the same cultural background, beliefs, and values. However, Maori and the Pacific doctors have remained significantly under-represented in the medical workforce. Although the 2012 survey of Medical Council of New Zealand has noted an increase of 2.9 percent in the number of Maori practitioners and a 1.6 percent to 1.8 percent increase in proportion of Pacific doctors, they remained to be under-represented.
Moreover, based also on the 2012 survey, doctors identifying themselves as Maori reported their main work roles as: General Practitioners (30 percent), specialists (24 percent), registrar (20 percent), and house office (15 percent). The Pacific medical practitioners also showed similar figures, reporting their work role as: General Practitioners (26 percent), specialist (22 percent), registrar (22 percent), and house officer (19 percent).
Government: Taking Measures and Initiatives
The New Zealand health workforce faces two problems. First, the demand for health workforce exceeds supply. Second, there is a lack of overall planning on the education and training of health practitioners. Hence, the government placed strategies to address these problems;
1. Voluntary Bond Scheme – This initiative by the Health Workforce New Zealand aims to move graduates into the communities and specialties which have high vacancy rates and to retain essential allied health professionals in New Zealand. Those on the scheme receive annual payments to help repay their student loan or cash incentives.
2. In 2009, government allocation was also put in place to increase the number of new medical training places over the next 5 years up to 200 additional places per annum, plus 50 new training places for general practitioners (GPs) over the coming year.
3. In August 2009, Health Workforce New Zealand Board was established to coordinate the education and training of doctors, nurses and other health professionals. The Board's role is to rationalise the planning and funding of health workforce training, with the aim to improve training, recruitment and retention of the health workforce.
Measures and initiatives are put in place to rapidly address the shortage of medical workforce, but unless New Zealand finds a way to increase retention of leaving medical specialists and to increase involvement of the marginalized Maori and Pacific doctors, the country could still be at risk of workforce shortage and be totally dependent on international medical graduates.