What?s up, doc?

Got a family doctor? You're lucky. Newcomers to Auckland find it hard to see a GP ? and the condition is going to get worse. Kylie Munro reports
Aucklanders are waiting up to six days to see a doctor as a growing shortage of GPs takes a grip on the region. Waiting rooms are overflowing and exhausted GPs have closed their books to new patients. The days of the traditional family doctor are fast weakening. Accident and emergency clinics are battling to cope with the overflow. Up to 40 per cent of GPs are set to quit in the next decade. With more GPs asked to ease the burden on a strapped hospital system, medical experts warn worse is to come. The Aucklander surveyed 112 medical clinics across the city, excluding accident and emergency centres, and found 11.6 per cent had shut their books to new patients. A further 10 per cent had at least one GP, and up to three, not taking new patients. Of the clinics surveyed, five in Manukau have closed their books, four in Waitakere, three in Auckland City and one in Rodney. On the North Shore, two clinics had at least one doctor not taking new patients. Most clinics could see patients within 48 hours or immediately for emergencies, but others reported up to six days' wait for appointments. Medical Association statistics show Waitakere has the lowest number of GPs of all New Zealand cities, with just one per 1666 people. The accepted minimum is one doctor for every 1400 people. Manukau has one GP for every 1538 people, the North Shore has 1369 people per doctor and Auckland City has the best ratio ? one GP for every 961 people. Royal New Zealand College of General Practitioners president Dr Jonathan Fox says the ageing GP workforce is diminishing faster than it is being replaced. Last week's Government statement ? promising $43 million over four years for medical clinics that keep patient fees low ? will help retain but not attract new doctors. A 2005 college membership survey says there will be a shortfall of between 2412 and 3618 doctors within 15 years if GP training is not increased. The average age of GPs has jumped from 42 in 1998 to 48 today, with 71 per cent aged 41 to 60. "Something like 40 per cent of the workforce could go in the next five to 10 years," says Dr Fox. "We are facing a grim picture. "New Zealand is short of doctors overall. It starts at medical school ? we're not training enough doctors." The college had 115 applications for GP training this year, but only 54 places. Our doctors are choosing to go into general practice overseas or into other specialties to wipe out student debts averaging $100,000, he says. The average GP earns about $90,000, but could easily earn 50-75 per cent more in Australia. "Or they won't enter general practice in New Zealand because other specialties get paid better. Even in the public system you'll earn 30-40 per cent more than your average GP." The survey showed GPs were looking to retire or move into other fields because they were overworked, stressed, bored and bogged down with bureaucracy and paperwork. Massey GP Dr Sue Hancock says protocols for patient paperwork, referrals and compliance requirements, such as audits and continuing medical education to stay registered, have tightened. "We always used to do that, but it was never formalised. I think there's a perception that because now you're formally required to do it, you're doing it more often and it's more onerous," she says. The shortage is compounded by increasing numbers of new female GPs looking to balance family life with part-time work, she says. "So, unless there are more doctors coming in than there used to be, there will be a growing gap between the number of doctor-hours available and the number of patients that can be seen." Dr Fox says it's harder to serve as a traditional family doctor. Patients see multiple doctors within a practice or turn to accident and emergency clinics when their GP is booked out. He should know: his Meadowbank clinic had closed its books for a year until finding a replacement doctor just four weeks ago. White Cross, which runs nine accident and medical clinics in Auckland, says patient volumes have increased 10 per cent in the last year. General manager Dr Alistair Sullivan says since 1988 the number of accident and medical clinics has jumped from three to 22 in Auckland. "That's because of the increasing inability of patients to get to see their GP when they need to," he says. The GP shortage will sting his clinics when regulations for South African doctors coming into New Zealand change on September 18. The New Zealand Medical Council will require South African doctors to sit a US or Australian examination and then the New Zealand Registration Examination. They will have to work one year as an intern. White Cross recruits about 20 South African doctors a year. "No South African doctor will come to New Zealand on those terms when previously they could get registered immediately and start work the next day," says Dr Sullivan. "You may go to your after-hours clinic to discover there isn't a doctor on duty because there are no doctors to work." The council says, "South Africa does not meet the requirements of a comparable health system".