KEY POINTS:
Can we resolve the medical workforce "crisis"? Barely a week has passed in the last two to three years when reference has not been made in the media to difficulties with recruiting and retaining doctors to work throughout the New Zealand health system.
Last week, there was renewed
focus on the loss of students overseas and New Zealand's high reliance upon overseas trained medical graduates.
While some deny there are issues with medical recruitment and retention, ensuring the New Zealand public has access to the right number of the right type of doctors who are able and willing to work across New Zealand is a more urgent concern than it has ever been. Whatever else may be said regarding the difficulties facing those of us concerned with the training of the medical workforce, what we do know is that New Zealand trains high-quality doctors who are well regarded internationally.
The challenge is to ensure we have a nationally co-ordinated system which can best meet the needs of New Zealand itself, at the same time recognising that our doctors are part of a highly mobile and sought-after international workforce.
There is no single solution to ensure we train a workforce to match the country's needs in terms of numbers and skills.
Multiple approaches are needed within our medical education and training system, some to be implemented immediately and others over time, to ensure that in five, 10 and 20 years' time we have the doctors required to meet the health needs of all New Zealanders.
An important part of the solution is undoubtedly to train larger numbers of students, but this will not have any immediate impact. It takes between 10 and 15 years to educate and train a doctor from their first day as a medical student to when they complete their vocational training.
Within three years of graduation, some 30 per cent of graduates leave New Zealand; some temporarily, many permanently. Strategies to reduce this early loss of trained medical graduates offer a pragmatic way to make shorter term gains.
Student debt, now averaging between $55,000 and $65,000, is a factor for many in their decision to leave New Zealand. The cost per year to educate a medical student is around $50,000, of which $11,000 is paid by the student in fees with the remainder covered as a tuition subsidy from government.
Students also borrow money to live. While it can be debated as to the impact of this debt relative to other professional graduates' immediate and life-time earning potential, there is no doubt it is a powerful factor in decisions around career path and emigration.
Targeted debt relief is one way of reducing the loss of our own graduates. This would see debt relief granted to medical graduates who stay in New Zealand, are employed in substantive selected training roles in New Zealand and who do not undertake locum work. By actively encouraging students to stay in the early years of their post-graduate training (three to five years would seem reasonable), it is much more likely they will continue to practise in New Zealand.
For an individual student graduating with an average debt of $60,000, the debt relief scheme could potentially halve this provided they continued their training here while working in the New Zealand health system for up to five years.
If such a scheme resulted in 50 more students staying in New Zealand for their training, the likely total cost would be no more than the upfront costs of having to train another 50 students.
Not only that, it has the benefit that the impact on the workforce would be seen far sooner - there would be more New Zealand trained doctors staying here.
This debt relief approach is different from so called "bonding" schemes in which students sign up for a specific post-graduate career path (which includes working in the health system) as a student and are exempted fees. Such approaches are unpopular, difficult to enforce and international experience has suggested they are ineffective.
It is encouraging to see public debate on how New Zealand will address the health workforce crisis we are facing. It is a crisis we share across the Western world but we must find our own answers. There is no single answer. In the medium term, we must look to train more students.
We have one of the lowest ratios of doctors per 1000 population and the difference between the OECD average and New Zealand has grown during the past 25 years.
As each year goes by, the situation worsens. On top of this, New Zealand's reliance on doctors trained overseas makes our medical workforce unique.
A recent OECD report makes the stark point that 52 per cent of the doctors working in New Zealand were born overseas.
A healthy degree of balanced medical emigration and immigration is appropriate but a position where there are twice as many overseas-born doctors working here as there are New Zealand-born doctors working overseas is a situation that exposes the country to risks that it cannot control.
The goal of delivering a medical workforce to New Zealand that meets needs now and in the future, while challenging, is achievable.
* Professor Iain Martin is dean of the faculty of medical and health sciences at the University of Auckland.
