It can take at least 13 years to train a hospital specialist and we are facing not only gaping shortages, but also an ageing workforce. Sarah Dalton looks at New Zealand’s worsening medical workforce crisis.
I listened to a well-known vaccinologist talking on the radio the other day. As they spoke about the effort needed to find and train hundreds more health care workers to deliver the Covid-19 vaccines, I reflected on the problems of matching our medical workforce to the health needs of Aotearoa.
When your health system is struggling under the weight of increasing population demand, with estimated specialist shortages of 24 percent, and hundreds of thousands of people waiting for or missing out on treatment, tangible and consistent medical workforce mapping is essential.
Ask senior hospital doctors and dentists what is the one thing that would most improve their working lives and care of their patients, and they will unfailingly answer with a plea for more staff.
Historically, and well before this global pandemic blew in like a storm from the north, there has been a black hole of reliable, centralised workforce information. Without information you cannot plan and without a plan you stumble along.
It is something that Health Minister Andrew Little acknowledged late last year when he told our (Association of Salaried Medical Specialists) ASMS Annual Conference “the idea there is no plan for workforce renewal and development seems criminal to me”.
The Health and Disability System Review also highlighted this issue. The review panel noted that “the future system will not be successful unless the workforce is planned and managed more effectively than has been the case in the past”. It went on to recommend we gather better workforce data.
Information on the makeup of the medical workforce is scattered. It is held by District Health Boards, the Medical Council, the medical colleges, and the Ministry of Health, but (and here’s the rub) it is neither joined up nor centralised.
The Ministry produced recent case studies highlighting ophthalmology and orthopaedics which show projected need. They tell us that demand for basic planned care like cataract surgeries and hip replacements will continue to outstrip supply, even as we train more eye specialists and orthopaedic surgeons. In these examples, even people with private health insurance (or money saved to pay for private care) might miss out, let alone those of us who rely on access to state-funded care in our public hospitals.
A complicating factor is that many of the professional colleges are Australasian which means New Zealand’s specialist workforce needs are a subset, rather than a key driver, when colleges make decisions about how many doctors enter training programmes and where they train.
And, if that is not tricky enough, New Zealand has about 10 medical graduates per 100,000 people – the seventh lowest in the OECD. Some might see a simple solution as creating more places at med schools, but it’s not that easy, requiring investment and planning at the other end. In an apprenticeship training model like ours, there just aren’t enough advanced training positions available, and we cannot afford to overwhelm already-stretched senior staff with larger numbers of trainees.
It can take at least 13 years to train a hospital specialist and we are staring down the barrel of not only gaping shortages, but also an ageing workforce. Take neurosurgery where surgeons are facing huge workloads and, in some regions, patients have limited or no access to speciality services. It is highly likely that in 10 years at least 40 precent of the 24 practising neurosurgeons will retire, yet for the past eight years, there have been no neurosurgery trainees in New Zealand.
Neurosurgery is just one example, but we could name so many more.
In advocating for future need, a proper census is required on the current state of the workforce.
A good model might be the first nationwide stocktake of our hospital buildings and facilities which was released last year as part of the National Asset Management Plan. Sensibly initiated by the former Health Minister David Clark, it provides a standardised register of assets to help prioritise capital spending and planning.
Just like an inventory of building assets, we need a detailed medical workforce census and centralised database. It needs to be one we can all use and from which we can map future need in a joined-up way. It also needs to look at our workforce through multiple lenses: acute and planned care demand, by specialty, by region, and in relation to current supply.
At the moment, a lot of information is protected although we understand the Ministry is working on making it more visible.
Management of the medical workforce requires proper funding with centralised co-ordination and oversight.
By better planning and future-proofing of our medical workforce, we can help future-proof access to core health services for New Zealanders.