Are healthcare students being driven out of the profession in New Zealand?
New Zealand has made significant progress in retaining its own medical graduates, with over 90% of graduates from the 2015-2018 cohorts remaining in the country for five years post-registration. This is a marked improvement from earlier cohorts, which had an average retention rate just below 80%. This positive trend may be attributed to initiatives such as the Ministry of Health’s Voluntary Bonding Scheme, which offers graduates incentives to stay in New Zealand in the years immediately following their graduation.
However, the situation differs for International Medical Graduates (IMGs), with over 60% leaving within the first two years of registration. According to the 2021 New Zealand Medical Workforce Survey, only 30% of IMGs remain in the country long-term. IMGs from the UK and North America often come for short-term stints or working holidays, whereas those from Africa, the Middle East, and Asia are more inclined to relocate permanently. Furthermore, doctors aged between 35 and 55 are more likely to stay compared to those in their 20s or over 65.
The hiring system for medical graduates in Aotearoa prioritises New Zealand and Australian residents trained locally, followed by residents trained in Australia, and lastly non-residents trained in New Zealand. An internal survey conducted by NZMSA in 2021 revealed that 68 out of 70 international students wished to stay and work in Aotearoa permanently after graduation. It would be unfortunate if roles could not be found for them.
In contrast, nearly one-third of nursing students drop out before qualifying, influenced by financial pressures, family responsibilities, and challenges exacerbated by Covid-19. Meanwhile, health boards and rest homes spend substantial amounts to attract overseas nurses to fill vacancies.
The rural-urban divide presents another challenge. University selection policies and undergraduate experiences can influence the future workforce's composition. Historically, rural students have been underrepresented, with only 3% of medical students from rural areas in 2002, despite these areas comprising 15% of the population. In response, both of New Zealand’s medical programmes introduced a rural origin admission pathway in 2004, later evolving into a regional-rural admission scheme (RRAS) in 2012 at the University of Auckland. Research indicates that extended rural immersion increases the likelihood of graduates choosing to work in rural settings.
Understanding when medical students and doctors make career decisions is crucial for universities, postgraduate colleges, and the doctors themselves. Career choices are influenced by various factors, including background, personal preferences, and job nature.
The current policy challenge for New Zealand’s health workforce is to align governance with effective implementation. This requires fostering skills in collaboration, and local execution.