Rotorua GP Dr John Armstrong retired in 2020. Photo / Andrew Warner
Doctors are battling burnout, GPs are closing books to new patients and the city's primary health organisation is reporting one doctor per 1700 people in its group as the doctor shortage worsens, and there is no simple solution, a doctor says.
Voices from the sector have said not enough doctors are entering general practice, while those indicating retirement within this decade combined with border restrictions made it difficult to fill positions.
Two years ago, Dr John Armstrong retired from his Rotorua practice, ending his medicine career of more than 40 years.
But it was not the first time he had done so.
Armstrong's first retirement had been several years prior when the stress of work burned him out.
He said the time he spent at work impacted on the time he spent with his own family.
"Looking back, I neglected my family. They suffered because I was not there. I tried, and I wasn't totally neglectful, but it wasn't until much later I realised how much I'd missed out on."
The model of general practice had to change in some way, and Armstrong said job sharing could be an option, which would allow doctors to pursue other interests.
When it came to younger doctors, he said they did not want to commit - there were plenty of other more attractive options.
As listed on Healthpoint, of the Rotorua Area Primary Health Services members, nine were not taking new enrolments. Five were, but three were with restrictions.
For example, Rotorua Medical Group's two practices had limited enrolment to household members of existing patients.
The primary health organisation's board chairwoman, Dr Genevieve Matthews, said she understood the national GP doctor to patient ratio was about 1:1300, while its own ratio was about 1:1700 patients.
She said GP burnout was real and significant across the whole country, not just Rotorua.
"We are under immense pressure to continue to provide 'business as usual' services, whilst being in the middle of an Omicron outbreak, which will only get worse.
"We have to keep on keeping on and support each other as best we can."
She was aware, anecdotally, of practices struggling to recruit and was aware of local GPs intending to retire soon.
The number of general practice trainees placed in Rotorua varied, but this year there were only two. This was of concern, she said.
"Unfortunately a number of practices, because their doctor to patient ratios have simply maxed out, have had to either close their books or restrict enrolments to patients."
Reasons for closing books were that practices could not provide good-quality, safe care to patients if their books were overflowing, she said.
And it wasn't just about doctors, it was nurse numbers too - "general practice relies on the whole team: doctors, nurses, admin staff".
While there were initiatives to attract younger doctors to the area, she said this took time and did not fill an immediate need.
"The problem is complex and there are no simple solutions."
Despite high patient ratios, she believed there was high-quality general practice care in Rotorua. She said the practices consistently scored higher than average in nationally run patient satisfaction surveys, which she saw as a testament to how hard the general practice teams work in the face of the challenges.
A workforce survey carried out by the Royal New Zealand College of General Practitioners in 2020 showed a rising number of GPs experienced burnout, and 31 per cent of GPs intended to retire within five years, and nearly half in the next 10 years.
College president Dr Samantha Murton said some of its regional areas struggled with lower doctor numbers per head of population. Often this was in places with older practitioners who planned on retiring.
"By 2030 we will have half the number of GPs."
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.
Incentivisation was lacking, Murton 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 on how to improve the situation, such as exposure to community health work during training and placements in general practices.
A Lakes DHB spokesperson said it was aware access to GPs in its area was difficult for some patients, in part because of numbers being insufficient for the population.
It had a working group that looked at options to increase GP numbers but said this would take time.
It introduced two new positions this month that would, each year, give six doctors in training additional time working in general practice in Rotorua.
"We are hopeful that giving junior doctors additional time working in general practice at this stage will help sway or consolidate their choice of GP as a career path and especially in the Lakes area."
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.
"In Rotorua, we understand over half of the general practices are listed as taking new patients."
In some cases, where a practice had reached the limit of the number of people who could be safely enrolled, they could close their books to new patients.
Patients should still be able to access health services at a local general practice as a casual patient, Perry said.
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 were not currently registered with a practice.
"General practices need to make sure they can support a manageable caseload of enrolled patients, which helps ensure that they can continue to provide their community with high-quality and readily accessible services."
In 2021, the Ministry of Health funded 210 trainees in their first year of general practitioner training – the highest intake into the programme to date. This funding began in 2020 until this year.
Since November 2021, 300 rooms a month in MIQ facilities were made available to offshore critical health and disability workers seeking to work in New Zealand.
By February, 92 GPs were issued a voucher.
The ministry continued to work with the sector on initiatives to increase capacity and capability for the rural health workforce, a spokesperson said.
They also said the reformed health system will provide additional opportunities in primary and community care.
The ministry valued the role GPs had in the health system, they said, as well as the recruitment challenges they faced.
"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, one less due to a GP relocating.
The ministry said shortages of health professionals can 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.
A scene guard is in place, and inquiries continuing, police say.