How do we shift to a sustainable healthcare system?
Written by Tom Varghese
International competition for doctors is increasing. Despite efforts in many OECD countries to become medically self-sufficient by training more doctors, significant shortages are forecast. Historically, New Zealand has been a net importer of workforce. Internationally qualified doctors and nurses make up a significant portion of the NZ’s health workforce (the second-highest proportion of international graduates among OECD countries), including 43% of the specialist workforce. The largest shares of foreign-trained doctors (between 70%-90%) come from within the OECD area. Some care settings rely more heavily on internationally trained health professionals than others. For example, in the aged residential care sector, about 44% of nurses are internationally qualified compared with 26% for all other settings.
Additionally, an ASMS report details that one in six New Zealand trained doctors are working overseas. This includes 723 specialists working in Australia in 2015 who gained their initial vocational qualification in NZ. This is a net loss of almost 100 New Zealand specialists to Australia since 2012. According to the MoH, 28% of international medical graduates and 12% of New Zealand medical graduates no longer practice in New Zealand after five years. This represents a loss of prior Crown investment in training (for the New Zealand trained medical graduates) but also places greater pressure on other practitioners to manage workloads. 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.
International medical migration trends are complex, influenced by a range of factors, including growing health needs, retention rates, economic and financial policies and domestic training policies, all of which are fluid. The NZ government is being told to act swiftly on immigration because delays are leading to the loss of urgently needed medical staff during the Covid-19 outbreak. Reports indicate that over 10,000 expressions of interest (skilled migrant) are waiting to be selected, including over 900 nurses and 235 doctors. In the other side of the fence, more than 200 international medics and almost 1000 nurses are on work visas because invitations to apply for residence have been suspended, and the complication from the delay is prompting some to head home. Literature tells us that three key factors influence whether healthcare staff stay or leave: quality of employment, work, and organisation.
Developing workforce plans will require more comprehensive and accurate data than is currently available. There is much better data for the DHB, medical and regulated workforce, but not for the non-regulated or non-DHB workforce. Ethnicity and disability data is also patchy.
With a looming 24% specialist shortage and hundreds on treatment waiting lists, new models of care and workforce mapping for renewal and development in NZ are critical requirements for success.
