General practitioner availability is "a trainwreck coming" as doctor burnout and retiring staff drive a shortage in the region.
That's the view of one leading doctor, with voices from the sector saying not enough doctors are entering general practice. This, border restrictions and upcoming retirements are making it hard to fill positions.
They say this leaves doctors overworked and burned-out, while some are closing their doors to new patients.
Bay of Plenty District Health Board chief medical officer and Fifth Avenue Family Practice GP Dr Luke Bradford told the Bay of Plenty Times general practitioners entered the sector because they cared for people and patients.
Many took their work home with them and as tasks mounted, family time was slotted in where it could be.
Bradford said he had seen burnout in colleagues, and he had seen it in himself.
"We all try and look after each other, but in the past, we have lost colleagues long-term to burnout.
"It can make you tired and irritable. It can make you distant from the people at home. You start to lose that passion of care you have for your patients and start to see it as a burden."
Burnout could lead to physical unwellness and mental health issues, as well as an inability to work full-time.
"It makes you feel helpless and guilty. There is a huge sense of shame with it, that you're failing your patients and colleagues."
Bradford said when doctors saw it in colleagues, many felt guilty they could not help or intervene "because you're struggling to tread water yourself".
Practices reaching capacity and closing their doors to new enrolments was an issue in the Bay of Plenty, including Western Bay of Plenty and Pāpāmoa, as well as Whakatāne.
Bradford acknowledged the Ministry of Health had given more money to GP registrar training but he said there were not enough coming through to fill gaps retirees left.
"Not being registered with a general practice is an immediate flag of poor health outcomes across all age spectrums. It's a real risk to the public."
There was hope the review of primary health care could result in change. Bradford said more GPs and Allied Health roles were needed if the primary care model were to unload pressures on the secondary care model.
To colleagues feeling burned out, Bradford said there was no shame in them putting up their hand. "That should be encouraged."
One Mount Maunganui doctor said colleagues described daily work as "being on the mouse wheel".
Dee St Medical Centre's Doctor Daniel McIntosh said, after speaking with colleagues, reasons for those leaving the profession included the advancing age of the workforce and constant pressures of complex presentations and increasing paperwork.
"The workforce is under immense pressure all the time."
There were examples of general practitioners choosing to work part-time to improve their work-life balance, going from five patients an hour to three, he said.
With too many patients and not enough doctors, it was a tight labour market and qualified, experienced GPs were hard to find.
He said there was definitely a need for change but it was complex, and training-based solutions would not have an impact for 10 to 15 years.
He suggested adequate GP funding was needed, as well as making the way practitioners worked more sustainable in the short term and attracting junior doctors to general practice.
"We're trying to be optimistic about what health reform will do for us."
The Western Bay of Plenty Primary Health Organisation supported 39 general practices across its area; this provided primary healthcare and wellness services for more than 200,000 people.
Of those 39 practices, 26 were taking on enrolments.
But of five Pāpāmoa practices listed on its website, only Papamoa Beach Family Practice was taking new patients.
Network services general manager Phil Back said general practices may decide to close their books to new patients after taking into account workforce and capacity issues that can impact the ability to safely deliver primary care services to their enrolled populations.
Some general practices have had to do just that, meaning people may have to find a practice further away from their home or workplace, he said.
The Bay of Plenty was no different to any other region in New Zealand experiencing a shortfall, but he said it fared slightly better than small provincial centres and the rural sector.
"New Zealand's border settings have also made it difficult to recruit overseas-trained doctors and get them into the country to fill gaps at times," Back said.
About 40 per cent of New Zealand's GP workforce was trained overseas.
A workforce survey carried out by the Royal New Zealand College of General Practitioners in 2020 showed GPs were leaving the profession because of burnout, as well as that 31 per cent of GPs intended to retire within five years, and nearly half in the next 10.
Back said the population had grown since the survey, and demand had increased.
"Across the Western Bay of Plenty PHO network to the year ending June 30, 2021, the net growth in enrolments at general practice averaged 398 each month."
There were 675,641 total patient contacts – an increase of 14,368 contacts over the previous year.
College president Dr Samantha Murton said some regional areas struggled with lower doctor numbers per head of population, often in places with older practitioners who planned on retiring.
To her, it felt like "a trainwreck coming".
If nothing changed, people would not get healthcare, she said.
She said about 300 needed to be trained each year to keep up with population growth and numbers retiring.
At the moment, this sat at about 200.
Incentivisation was lacking, she said, as well as exposure to the work during medical training; most undergraduate training was on hospital wards.
"By the time you've got doctors looking after 1500-2000 patients per year, then that is an enormous amount of work. The burden on GPs is really high."
She said the college was talking with the Government about how to improve the situation, such as exposure to community health work during training and placements in general practices.
Ministry of Health health system improvement and innovation deputy director-general Clare Perry said about 94 per cent of New Zealanders were enrolled at a general practice.
She said it was working with the primary care sector, primary health organisations and district health boards to find innovative solutions and implement changes to improve access for all New Zealanders, especially those who are not currently registered with a practice.
In 2021, the Ministry of Health funded 210 trainees in their first year of general practitioner training – the highest intake into the programme since it launched in 2020.
Between November and February, 92 GPs were issued an MIQ voucher to come to New Zealand. Three-hundred rooms a month are being made available to offshore critical health and disability workers seeking to work in New Zealand.
The ministry continued to work with the sector on several initiatives to increase capacity and capability for the rural health workforce, a spokesperson said.
They also said the reformed health system would provide additional opportunities in primary and community care.
It recognised the role GPs played in the health system, and the challenges with recruitment and retention, including the number of vocationally registered GPs retiring.
"The response to Covid-19 has added to GP workloads and highlighted the importance of growing and maintaining our workforce."
In June 2020 there were 3746 vocationally registered GPs working in New Zealand, and in June 2021 3835, an increase of 89 GPs.
For the Bay of Plenty region, in June 2020 there were 227 GPs and in June 2021 there were 226, due to a GP relocating.
They said shortages of health professionals could impact sustainable and equitable access to healthcare services and there were initiatives that would help recruit and retain GPs in the short and medium term.