Where have all the doctors gone?

A lack of doctors to cover shifts at Dargaville Hospital is just the tip of the iceberg when it comes to staff shortages, says one doctors union. How did New Zealand’s hospitals get to this point?

A patient going into cardiac arrest at Dargaville Hospital with no doctor to treat them last week has thrown the struggle to staff the country’s health system into sharp focus.

As Health Minister Dr Shane Reti fielded questions on Tuesday about the Dargarville situation, news emerged that Kenepuru Community Hospital in Porirua was also having to call in a telehealth company to help cover afterhours care.

But Dargaville and Kenepuru are far from the only hospitals facing a workforce crisis, according to Sarah Dalton, Executive Director of the Association of Salaried Medical Specialists (ASMS).

“You could almost pick a hospital, pick a place, go in, spin around, throw a dart and it will hit a space where a doctor should be,” she said.

Dalton said the doctor shortages are very widespread, but medical specialties that are particularly feeling the pinch right now are psychiatry, dermatology, haematology, obstetrics and gynaecology, radiology, radiation oncologists and intensive care specialists.

The doctor shortage is especially apparent in hospitals away from the main centres, Dalton said.

While Northland’s hospital services have been in the news this week, Dalton said there have been staff shortage issues noted in hospitals in Taupō, Rotorua, Whakatāne, Queenstown, the West Coast, and Gisborne, too.

“These smaller, rural hospitals are just often overlooked, and they are harder to recruit to,” Dalton said.

A perfect storm of issues has been building around the health workforce for some time.

Part of the problem is what Dalton said was an “unwillingness to resize the service”.

“What that means is back in 1990 there would be a decision made that 10 doctors was the right number for a particular service – and that may not have been reviewed for many years,” she said.

“Meanwhile, population growth has gone on [and] acute admissions have gone up.

“It might be that if you really looked at things now based on actual population growth and need, they might [require] 15 or 20 doctors – so even if they're fully staffed, they still don't have enough people to do the work that the community needs.

“Even vacancy rates at the moment don't tell the whole story.”

New Zealand also has a massive junior doctor shortage as well, Dalton said, which doesn’t help.

“We are hearing a number are going to Australia, although they're more likely to go towards the completion of their training,” she said.

“So, they train [in New Zealand] and then they're going to take the qualification and go and earn big money in Australia and not come back.”

Dalton said New Zealand once had significant cohorts of junior doctors arriving from the UK and Ireland to work for a year or two as part of their training, but those numbers had dried up since the Covid pandemic began.

“There was reliance on those [junior doctors],” she said. “All parts of our system rely on overseas trained clinicians to some extent.”

While the Budget allocated funding for 25 more first-year medical school places from 2025, Dalton said New Zealand is not training enough doctors.

The Government and Tertiary Education Commission set the number of first-year medical school places. There will be 614 spaces next year, split across the Universities of Otago and Auckland.

The NZ Resident Doctors’ Association (NZRDA) told 1News another 300 medical school placements are needed right now.

The Government’s plans for a third medical school based at the University of Waikato are still some way off, but Dalton said New Zealand needs to get braver and start training more doctors sooner rather than later.

“Because it takes [medical students] six years to get through university, we’ve got six years up our sleeves to think about what will be the pressures on supervision and training that will emerge as they as they come out of universities,” she said.

Training more doctors is, of course, not a quick fix to the problems hospitals are experiencing today.

Prospective doctors must spend six years at medical school before working in a hospital as postgraduates for two years.

At the end of those combined eight years, they can get general registration to practise as a doctor. Should those doctors want to become GPs or specialise in certain areas, more training follows. Some specialties can mean 15 to 20 years of training all up.

But both the NZRDA and ASMS say New Zealand could do much better when it comes to attracting and retaining already qualified doctors.

That includes competitive terms and conditions of employment, especially when there’s global health staff shortages and the opportunity to earn much more money practising medicine in Australia.

“We really do need to take a hard look at core terms and conditions, and we need to incentivise people to work in rural and remote areas; we need to incentivize people to stick around,” Dalton said.

She said some specialties, particularly psychiatry, were seeing people resigning from their permanent jobs to work as locums, because the locum pay rate can be very high in some places and offers flexibility in how often they work.

“Whereas people who are working full time as psychiatrists are just slammed and they're not being offered incentive allowances or rural and regional allowances or hard-to-staff allowances to recognise the difficulty of their work,” she said.

“So, we've actually created perverse incentives where we're actually encouraging people to casualise their labour rather than commit to the public system.”

The NZRDA also highlighted the need for security of employment for emerging specialists. There is currently no guarantee of employment for those training as specialists in New Zealand.

Dalton said the promised benefits of disestablishing district health boards (DHBs) to create Te Whatu Ora, such as making sure health staff were placed where the need was greatest, did not eventuate.

But, she said, there is some good workforce planning starting to be done now.

Health Minister Reti told reporters this week that the health workforce was a "prime issue" for the Government and a workforce plan would be released “in about another month or so”.

Those comments came as Reti deflected questions around his assertion that Health NZ Te Whatu Ora had previously been operating with 14 layers of management. The Government sacked Health NZ’s board last month and replaced it with a commissioner, Professor Lester Levy, due to concerns around oversight and overspend.

Dalton said ASMS members would like to see more honesty in health leaders’ comments around the current system.

“[They could say] ‘we understand the reasons why people are having to wait so long for care,’” she said.

“It’s not because we’re not being productive, it is because we don't have enough staff to beds, or it is because we don't have enough operating theatres.

“It's not because of the clinicians doing the work; they're working their guts out and every time some statement comes out suggesting that we could just be more efficient or more productive in the health system, it's like another kick in the guts to the guys out there trying to do that work.”

Prime Minister Christopher Luxon said on Monday that situations like the one that took place at Dargaville Hospital were "incredibly challenging".

"I know there's lots of other pressures in the health care system as well, so I'm not admitting, I'm not saying that the system is perfect by any stretch but what I am saying to you is that we understand that and we are working incredibly hard to make sure that ... we put more staffing into our healthcare system, we have clear targets about what is actually expected from the system ... and we make sure we continue to grow our workforce.”

Dalton said more needs to be done to incentivise doctors right across the health workforce.

“Primary and preventive care is where we get the biggest health wins long term, so how can we incentivize people to train as GPs?” she said.

A Te Whatu Ora briefing to the Health Minister in January said New Zealand is nearly 500 GPs short of what it needs. That number is expected to surpass 1000 in the next decade.

“How can we bring more job satisfaction back? How can we support people and make working as a GP in a community an attractive, positive thing,” Dalton said.

“Let's look at where we have the greatest need and let's incentivise people to pick up those training pathways.”

Dalton said people might find it odd that doctors need to be better paid given what they might be earning already.

“But I think most New Zealanders also understand that training to be a doctor is gruelling – it takes a long time and not everybody makes it,” she said.

“And the most important thing if you or a loved one is sick or is in an accident and needs care is you just want to know there are the people available to see them.”