Doctor selling point: No fear here

Where have all the doctors gone - to America.

One of the key elements in the maternity services debate is how to attract obstetricians and gynaecologists to work in our fair city. The shortage of medical specialists is not peculiar to Whanganui - it is a nationwide dilemma.

Recruiting and retaining doctors is also an international problem. There have been articles in the UK's Guardian and the New York Times asking where have all the doctors gone?

Apparently they go to America. A variety of interlinking factors are cited as the drivers of this dynamic. One is that the US does not train enough doctors to meet its own needs so it recruits from all over the world. About 200,000 of the doctors practising in the US were trained in other countries.

This valuable resource, trained at the expense of other countries, many of which are struggling to provide adequate healthcare for their own people, has been taken by the US. The Guardian article cites Liberia as an example. In 2002, it had 72 doctors working in its own country and 47 Liberian-trained doctors working in the US.

Consider the following. According to international statistics, Zambia has 0.12 doctors per 1000 people. The US has 2.3 per 1000 and New Zealand has 2.2 per 1000.

In Zambia life expectancy is 46. More than one million of its population of 14 million people are living with HIV or Aids and more than one in 10 children will die before they reach the age of 5. Zambia has one doctor for every 23,000 people. The US has about one for every 416 people.

The ability to offer competitive salaries is another part of the dynamic. The New York Times notes the median salary of a surgeon in New Jersey is $216,000. Compare this with about $24,000 a year for a surgeon working in the main hospital in Lusaka, Zambia. It does not require a brain surgeon to work out the maths.

Another critical element in the field of medicine is the move towards more sub-specialties. There are now consultants who specialise in one aspect of health, where once the emphasis was on training generalists who could turn their skills to a wide range of health problems. (Some readers will recall a time when the family GP delivered babies)

The US has increased the odds of getting the best and brightest by laying out a legislative welcome mat. The government offers a deal to foreign doctors on J-1 student visas: They can stay on in the US once they have finished a residency in an American hospital, provided they agree to practise in communities where doctors are in short supply. The US, using this legislative trick, has about 8500 foreign doctors providing services in challenging environments.

In the global market, the combination of increasing specialisation, compounded by an international skills shortage mixed with who can offer the highest salaries and high-tech medical facilities, means it comes down to the classic "he who has the most toys wins".

What can little ol' NZ do in such a competitive market? The look of astonishment on an American doctor's face when it was explained that NZ doctors do not work in a treatment environment driven by the constant fear of being sued might provide a clue. Perhaps New Zealand needs to use this "secret" weapon better as it bids to retain NZ-trained doctors and attract some of the best from overseas.

Terry Sarten lives in Whanganui. He is a writer, social worker and musician. Email: tgs@inspire.net.nz