Whangārei doctor Paula Mathieson says she has reduced her income and extended the mortgage on her home to "keep the doors open" at her practice. Photo / Tania Whyte
GPs Paula Mathieson and Shane Reti once worked in the same doctor’s practice in Whangārei. Now their paths have diverged: she is deeply in debt and he is the most powerful person in New Zealand’s health system.
A doctor who works in a Whangārei clinic set up by Health Minister Dr Shane Reti says she is in “more than six figures” of debt because of chronic underfunding of general practice.
Dr Paula Mathieson, a family doctor for 30 years, said GPs were desperately seeking certainty from the minister about their future funding.
She works at Rata Family Health in Whangārei. Reti still owns the building, and she has previously employed him as a locum to allow him to retain his practising certificate.
“Dr Reti has been a great support for me in the past,” she said.
“I do get more opportunity than most GPs to talk with him, so he is aware of the issues. And I can fully understand he can’t announce things outside of Cabinet.
“But it would be nice if he could give us a bit of an indication about what’s happening. For us, it has reached a critical point and we can’t see any way out of it without the Government coming to the party.”
Reti agrees the “capitation” funding model is not fit for purpose and has said he has sought advice on improving it.
GP advocacy groups say the evidence base and political consensus is already there - successive governments have reviewed the funding formula - and urgency is required.
“I’m not that impressed with Shane, and by inference the Government, saying, ‘We are going to have a look at it again’,” said Mathieson. “It is stalling, and we have got to the point that we are running out of time.”
She is equally frustrated with the previous Labour-led government, saying it failed to act on the Sapere Report, which recommended a funding boost and an overhaul of the funding model.
Reti did not directly address his former colleague’s comments but reiterated that the funding model needed to change.
“We all want a sustainable solution for primary care providers – we know what a vital role primary care plays in health,” he said in a statement.
Speaking to reporters at an event in Manukau today, Reti said any changes to funding would be guided by the principles in the Sapere Report.
“To be frank, I’m not desperately interested in another review and waiting another one, two or three years. I think the reviews have been done and general practices are aligning around the principles that came out of the review. Now it’s for us to think about how to implement them.”
The Herald reported last week that many clinics were raising their fees because their capitation funding was increasingly inadequate. This was adding further pressure to a sector which was grappling with widespread shortages and burnout.
At least 170 primary care and urgent care clinics have warned their Primary Health Organisations (PHOs) that they may no longer be able to provide services. Those warnings were in response to a pay equity claim by practice nurses announced in December, which will lead to significant pay rises for nurses if successful.
Mathieson said she wanted to speak out on the issue to address persistent myths about GPs, in particular that they were “rich and greedy”. She said it was important the public knew that the Government controlled virtually all of their income.
The Sapere Report estimated fulltime GPs earn around $258,000 a year in New Zealand.
Mathieson said she earned around half of that total, partly because she has reduced her hours but also because of the high costs of having a large number of complex patients. She has taken out “six-figure” business loans and a similar amount on her own mortgage. She is 58 years old but has no retirement savings.
At a time when the Government is lifting graduate numbers and trying to encourage more doctors into general practice, she was advising against it as a career choice.
“It’s a great job and I would recommend it, but not in the current environment. I tell people to steer clear.
“It’s a stressful job to start with, and then you add financial stress to it - it’s just too much.”
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GenPro chairman Dr Angus Chambers said the existing funding model, which is 20 years old, disadvantaged clinics with older, poorer or more complex patients.
“We get the same amount of funding for a 65-year-old patient as we do for a 95-year-old patient, and yet 95-year-olds inherently have a lot more needs.”
Rata Family Health is a Very Low-Cost Access (VLCA) clinic, meaning it gets additional funding but must charge low fees. Adults pay no more than $19.50 for a typical consultation. The capitation funding and co-payments no longer cover the clinic’s costs and it was not allowed to raise its consultation fees to fill the gap.
Mathieson has reopened her books to bring in more funding. She now has 2100 patients on her roll, well above the recommended “safe” level of 1200 to 1300 patients. This move also increased the proportion of her patients classed as “high needs”. They now make up 42 per cent of her roll.
The Sapere Report, released in 2022, concluded GP funding did not align with patient need: “This means that services that have a higher than average proportion of people with high needs are not funded adequately to deliver care to their patients.”
Isaac Davison is an Auckland-based reporter who covers health issues. He joined the Herald in 2008 and has previously covered the environment, politics, and social issues.