Health workforce migration: The case of UK and New Zealand Universal health care is perhaps one of the most important goals for policy-makers in Commonwealth member countries. Evidence indicates that accessible health care, delivered at the right time in the right locality, can reduce overall health care costs (Nolte and Pitchforth, 2014; Starfield, Shi and Macinko, 2005). It can also contribute to improvements in the quality of care and to ensuring the health workforce is optimally deployed. Of course, this last point implies availability of a health workforce with the right mix of professionals, working with an appropriate scope of practice, and support staff. This is particularly important given the rise in chronic disease and corresponding demand for long-term condition management, driven in part by population ageing. Most Commonwealth member countries face substantial challenges in building and sustaining their health workforce. The challenges come from capacity to train health professionals, and train enough of them, as well as workforce retention and distribution in a context of global health workforce migration. Many countries rely heavily on inward migration to provide for the health workforce needs of this demographic, while watching their own trainees go abroad in search of better opportunities. This article case studies the medical workforce in New Zealand, a highincome country whose health care system would not function without migrant professionals. Presently, some 44 per cent of New Zealand’s doctors and more than a quarter of nurses are migrants. New Zealand has also historically been among the highest exporters per capita of locally trained health professionals (Zurn and Dumont, 2008). New Zealand draws its international medical graduates (IMGs) from a range of countries, but the UK is the dominant source. This has been a source of concern in the UK, whose General Medical Council reported in 2014 that 51 per cent of ‘certificates of good standing’ were issued to postal addresses in Australia and New Zealand (GMD, 2014). One newspaper suggested that ‘they cost £610,000 to train, but 3,000 a year are leaving us for a life in the sun’ (Borland, 2014). Of these, around 500 per annum seek work in New Zealand (MCNZ, 2013). Their replacements in the UK are increasingly doctors from EU member countries. Medical migration may be a concern for UK policy-makers, but these doctors are crucial to New Zealand, which, with IMGs composing 43.6 per cent of the medical workforce in 2014, has the highest proportion of any OECD (Organisation for Economic Co-operation and Development) member country. Furthermore, this proportion has been growing over time. Half of New Zealand’s present 3,500 IMGs hail from the UK and go into a health system not dissimilar to the NHS (See Box: ‘New Zealand’s health system’; HWNZ, 2014). Yet, these doctors do not provide for workforce sustainability. A year after registration, only 53 per cent of UK doctors remain in New Zealand, dropping to 30 per cent after two 124 Commonwealth Health Partnerships 2015 years and 20 per cent after eight. By contrast, 70 per cent of New Zealand-trained doctors are still there after eight years, suggesting that a locally grown workforce is more likely to contribute to sustainability (MCNZ, 2013; HWNZ, 2014). The costs of medical migration for New Zealand, and countries facing similar challenges, are huge. These include recruitment and associated costs, such as relocation, locum coverage for vacant posts and supervision for new recruits seeking medical registration. What motivates UK-trained doctors to migrate abroad? What are their experiences in a country such as New Zealand? And if they like a ‘life in the sun’, why do they only go down under for a short time? To address these questions, we present findings from research conducted in 2014 into motivations and experiences of UK doctors practicing in New Zealand. A high proportion are attracted to New Zealand by its more relaxed lifestyle, better working conditions and postgraduate training opportunities. But many indicate they fled the UK’s NHS because of frustration with clinical practice and NHS reforms, and workplace stress. What we found The survey1 included a series of fixed-response Likert-scale questions on motivations for the move to New Zealand. ‘Quality of life (or that of my family)’ was indicated as ‘important’ or ‘highly important’ by 96 per cent of respondents; 87 per cent indicated more attractive working conditions; and 72 per cent said it was availability of career opportunities. Notably, 65 per cent indicated a ‘desire to leave the UK NHS’, with a third of all respondents indicating that this was ‘highly important’. Only 38 per cent agreed that ‘more attractive salary and incentives’ motivated their move, with less than ten per cent saying this was highly important. Proportional odds regression analyses highlighted that older respondents (those 41 years of age and above) were less inclined to agree than 20–30-year-olds (the reference group) that quality of life was an important motivator (all regression findings henceforth discussed are statistically significant at p<0.05). Registrars were also less likely than hospital specialists or general practitioners (GPs) to be seeking a better quality of life, but more than twice as likely as GPs to be motivated by ‘training and development goals’. When it came to the desire to leave the NHS, we found that younger doctors (20–30 years of age) were around four times as likely as older doctors (aged 51 and over) to agree that this was a motivating factor. We asked survey respondents a series of questions about their work and living environment in New Zealand, factors deemed important to workforce sustainability. Overall, they were a relatively happy group with more than 90 per cent satisfied with their workload, work colleagues and community life, and with the New Robin Gauld and Simon Horsburgh
Commonwealth Health Partnerships 2015
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