Fernanda Marano has close to a decade of experience as a gynaecologist and obstetrician.
She’s been exploring pathways to work in her chosen profession since moving to Napier from Brazil in 2018.
But as close to 900 women in Hawke’s Bay sit on a waiting list to see a gynaecological specialist, Marano spends her days running a cleaning business.
“I want to give back to the community but I just can’t,” she said.
“I’ve seen so many women here desperate for help with gynaecological issues. Friends, friends of friends, clients ... and I can only offer advice.”
Health NZ director of operations for Hawke’s Bay Rika Hentschel said the waitlist for a first specialist appointment in the region dropped from 912 to 882 between June 30 and July 14.
“We expect to see more progress in the coming months. We are recruiting for an extra senior medical officer to join our gynaecology team at Hawke’s Bay,” Hentschel said.
“We know we have work to do to get more women seeing a specialist sooner. We are working hard to improve wait times for patients.”
Marano said she would love to be able to help alleviate wait times in the system.
“I know I could.”
More than 70% of New Zealand’s medical workforce is currently trained overseas.
Yet many face “long, costly, and uncertain” paths to practice, depending on the country they come from.
Marano spent nine years studying in Brazil and almost 10 years practising in women’s health before moving to NZ for a “better work-life balance”.
“In Brazil, some days I would work over 24 hours straight. Clinic all day, then night shifts from midnight to 7am with barely any breaks,” she said.
While she has found the quality of life she hoped for in Napier, the path to her practising medicine in NZ is expensive and with no guarantee of success.
All up, Marano said her costs could potentially exceed $20,000.
“And the worst part is, even after passing exams, they can still understand you’re not the right fit,” she said.
“What if I invest all that time and money and still get rejected? The risk is too high.”
According to the Medical Council of New Zealand (MCNZ), fewer than 1% of applications are declined.
Marano, who secured residency in 2022, still hopes to validate her diploma but said change is needed.
“There’s no visa to go through the process. As an immigrant, you need a working or studying visa to stay.
“How can you work fulltime, study for exams, afford the cost of living and pay all the fees?
“It’s fair to have standards. But if we need doctors this badly, why not make the process more accessible and affordable? Like a visa for overseas-trained specialists going through registration.
“That would benefit not only those from countries with weaker currencies, but also high-need areas like Hawke’s Bay.”
Augustina Montes, a Napier resident since 2017, spent years navigating the same system.
She is a qualified paediatrician from Argentina who recently became registered as a doctor in New Zealand.
“I tried studying [for the exams] while I was on my work visa, working fulltime as a support worker. I found it impossible,” she said.
“Once my residency visa came through and I was able to change jobs, I passed both exams within two years.”
She said the registration process was “hard, lengthy and expensive”, involving several steps including verifying her credentials through an international database, sitting the Australian Medical Council multiple-choice exam and an English test, followed by the practical NZREX exam.
“After you pass this last exam, you need to get a job as a first-year or postgraduate year one at the hospital, which can be tricky to get.”
Montes estimated she spent about $10,000 on the process, not including additional costs such as travel, accommodation and translation of documents.
“It was really hard … I considered giving up many, many times,” she said.
“The hardest thing is not the exams themselves, but the fact that there is no immigration path for us, or enough guidance.”
Health Minister Simeon Brown said the Government was committed to growing the frontline healthcare workforce, with a recent additional $16.68 billion boost for the sector.
“There is untapped potential in New Zealand with many overseas-trained doctors living in this country, but for too long the system hasn’t recognised their qualifications or experience,” Brown said.
He said that was now changing and making regulatory settings easier for overseas-trained doctors to practise in New Zealand was a priority for the Government.
“In late March, the Government invited New Zealanders to take part in the Putting Patients First consultation, which emphasised the importance of more enabling policy settings to attract overseas-trained medical professionals.
“The Ministry of Health is working closely with the Ministry of Business, Innovation and Employment on immigration settings to make sure New Zealand has the skills and capabilities to meet patients’ health needs.”
Brown launched a new two-year training programme in March to support up to 100 additional overseas-trained doctors to receive their New Zealand registration.
Applications closed on May 31, with 184 expressions of interest received. The first group of 10 began the programme in Waikato this month.
“I encourage any overseas-trained doctors who are living in New Zealand, and who are interested in these pathways, to get in touch with the Medical Council or Health NZ to discuss the pathway forward for them to begin practising in New Zealand,” Brown said.
Harriet Wild, director of policy at the Association of Salaried Medical Specialists, said New Zealand had one of the highest rates of overseas-trained doctors in the world, but the system doesn’t always support them effectively.
“We hear all the time from our overseas-trained members,” she said.
“Historically, we haven’t done a great job supporting them ... and that really needs to change so that we can hold on to them and they can continue to contribute to our health system here, where they’ve chosen to come.”
MCNZ’s chairwoman Dr Rachelle Love said retention remained a challenge, with many overseas-trained doctors leaving within two years.
“That’s why we’re calling for stronger support systems, like mentoring, settlement help for families and comprehensive feedback on why doctors choose to leave.”
Last week, MCNZ announced changes to make it faster and easier for doctors from the United States, Canada, Singapore, Chile, Luxembourg and Croatia to register via the comparable health system pathway.
Love said most applications are processed within 20 working days.
“We’ve introduced fast-track registration pathways for eligible specialists, expanded recognition of comparable health systems and trebled capacity for our New Zealand Registration Examination.”
While she said most applicants pay between $600 and $1800 in direct fees, total costs to have medical qualifications recognised could potentially reach as much as $20,000 for overseas-trained specialists from non-comparable countries, once exams, bridging programmes and other requirements are factored in.
Love said the higher fees for specialist registration reflect the complexity of some pathways, which involve expert college assessments of overseas doctors’ qualifications.
“Any fees paid by applicants for medical college advice are remitted directly to the college and we do not receive any net financial benefit.”