Zealand health system being ‘easy to work in’. Eighty per cent agreed that ‘the New Zealand health system is better to work in compared to the UK system’, with more than 40 per cent strongly agreeing with this statement. Regression results showed males and older respondents (41 years and over) were less likely to agree, while hospital specialists and registrars were considerably more likely to agree than GPs. Asked about motivations to leave the NHS, GP respondents, in particular, cited a stressful working environment with a high volume of patients and very limited time to see each one. One respondent, a GP who had arrived in the country in 2012, said of general practice in New Zealand: ‘Few home visits due to dedicated afterhours centre staffed by rostered GPs, longer GP consult times, less squeeze on appointments, more opportunity to perform practical procedures and work patients up before referring to secondary care.’ Hospital specialists also emphasised a desire to leave behind stress and frustration: ‘… We were being expected to do more and more with less ... it felt like it was assembly line medicine. The work pressure was just extremely intense and combined with a long commute I felt like it was going to be quite deleterious for my psychological health and family life.’ – Specialist, arrived 2014 Given its high IMG attrition rate, we asked survey respondents whether they were considering a move away from New Zealand – 29 per cent indicated they were. We asked this subset (n=181) to rate their level of agreement or disagreement with a series of considerations. At 76 per cent, the highest scoring factor was ‘desire to return to a country (e.g. UK) where I had previously lived/worked’. Next in order of importance, at 55 per cent agreement, was availability of career opportunities elsewhere. Some 24 per cent were motivated by ‘more attractive salary and incentives elsewhere’, and 20 per cent by a ‘better lifestyle elsewhere’; only 15 per cent cited a ‘poor working environment’ in New Zealand as being a consideration. We asked interviewees what would motivate them to want to leave New Zealand. Many suggested home and family: ‘Home is home, and there is a lot more of the world we want to live in too. But we hope to return to NZ for another year sometime.’ – GP, arrived 2011 Finally, we asked 16 interviewees to compare and contrast the NHS and New Zealand health systems, including which they found preferable to work in. There was a mix of views: ‘I think work conditions in NZ are vastly superior to the UK – at the moment. I enjoy working here and I suspect I would be quite burnt out if I had remained in the UK.’ – GP, arrived 2012 ‘Although overall it is a better place to work than the UK, the NZ health system is not a bed of roses: Pharmac New Zealand’s drug-buying agency is more restrictive on drug availability than NHS, social support in the community is poorer, there are more co-payments that act as a disincentive for poorer people to seek health care.’ – GP, arrived 2008 H e a l t h wo r k f o r c e mi g r a t i o n This last point poses particular challenges for achieving universal health care in New Zealand – one that policy-makers have yet to tackle. Will the ‘life in the sun’ last? The UK has a long tradition of supplying doctors to New Zealand dating back to early colonial settlement and, in 1875, the founding of its first medical school (Page, 2008). In this context, the UK doctor going Down Under for a spell is nothing new, but there has been increasing recognition that New Zealand’s reliance on IMGs is not ideal (Zurn and Dumont, 2008; NZ MoH, 2006). The public hospital doctors’ union has campaigned vigorously for growing the local workforce (ASMS, 2013; 2014); the government, also, has acknowledged the need for investment (HWNZ, 2014). Since 2007, medical training places in the two New Zealand medical schools have almost doubled. However, they continue to produce fewer medical graduates than the OECD average. Its doctor-to-population ratio of 2.6:1,000 people is also below the OECD 3.2:1,000 average (MTRP, 2014). As New Zealand works to grow its medical workforce to keep pace with health care demands it is likely, in the short term, to continue relying heavily on IMGs, especially in areas with crucial shortages, such as rural general practice and psychiatry (HWNZ, 2014). But the situation could change quickly for two reasons. First, the market in Australia, a traditional ‘life in the sun’ for New Zealand doctors, is tightening up as it graduates doctors from ten new medical schools established since 2000 (MTRP, 2014). Second, new schemes to keep New Zealand doctors at home after graduation are starting to have an impact, along with the increased medical school output (HWNZ, 2014). In the meantime, if the UK and other countries are concerned about outward migration of doctors and workforce sustainability New Zealand’s health system New Zealand’s 1938 Social Security Act was the world’s first attempt to create a ‘national health service’. Medical resistance meant the intent was never realised. Public hospitals salary all staff and are free of patient charges, however, GPs are largely in private practice and act as gatekeepers (see page 225 for more details). They receive considerable government subsidies but charge most patients a fee per consultation, creating an access barrier (Jatrana and Crampton, 2009). The government contributes 83 per cent of total health expenditure, as in the UK. Around 40 per cent of public hospital specialists have a separate private practice. This means patients of better means are able to circumvent public hospital waiting times or access treatments considered to be of lower priority in the constrained public sector (Gauld, 2013). As such, New Zealand has a two-tiered health system, despite considerable government investment and commitment to public services. Long waiting times are common for non-urgent hospital services and those who can pay routinely seek treatment in the private sector, where professionals generate much higher incomes than in the public sector. Health professional shortages contribute to this situation. The challenges New Zealand faces are magnified in many less developed countries. Commonwealth Health Partnerships 2015 125
Commonwealth Health Partnerships 2015
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