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HWAC Review of the Medical Workforce

Wednesday 18 May 2005

HWAC Review of the Medical Workforce

Major changes are required in the way in which medical education is organised and delivered in New Zealand.

That?s one of the key findings of 'Fit for purpose and for practice: a review of the medical workforce in New Zealand' ? a consultation document released today by the Health Workforce Advisory Committee (HWAC).

The review was carried out by HWAC's specialist Medical Reference Group (MRG).

It looks at the current workforce and considers the likely impacts of a wide range of issues on the workforce of the future. These issues include demographic change, medical workforce characteristics, changing concepts of professionalism, the global medical labour market, and issues in training, development, recruitment and retention.

Dr George Salmond who is the chairman of the Medical Reference Group says, "While New Zealand is a world leader in many health strategies such as primary health care, its health workforce development has not kept pace with the changing demands for doctors both in New Zealand and overseas."

"The issues identified are complex. There are no quick or easy answers. Action is required on a broad front. Leadership and concerted action are identified in the document as pivotal to developing a workforce which meets the demands of a rapidly changing health system. A well organised, concerted and sustained effort is required."

The consultation document identifies immediate priorities for consultation and early action.

These include:
* Strengthening and increasing the primary health care workforce, particularly in general practice.
* Change and innovation in the structure and process of both undergraduate and postgraduate medical education.
* Innovative approaches to balance service commitments and training requirements and improve inter-disciplinary communication, team work and patient care.
* Well-structured, ongoing vocational guidance and mentoring for medical students and recent graduates.
* Better informed and organised support for vocational decision-making and early career development.
* Clear strategies, policies and well-designed and publicised incentive schemes for the recruitment and retention of doctors in areas of special need.
* Better gathering, analysis and reporting of workforce information.
* A systemic, sector-wide approach that links health sector strategies and workforce development.
* Leadership at all levels across the health system to drive service and workforce redesign and development.

"A lot of the issues facing New Zealand's medical workforce such as the impact of the ageing population and the increased demand for doctors and other health professionals are also faced by other western countries - the challenge is how we address these in both the short and longer term" said Dr Salmond.

Submissions on the consultation document are being sought from a range of professional bodies and organisations in the health sector, as well as individual practitioners, and members of the public.

Copies of the consultation document may be accessed at, submissions close on 29 July 2005. Hard copies of the document will be available from Friday 20 May 2005.

Background information

1.What is the Health Workforce Advisory Committee and what does it do ? HWAC was established in 2001 to provide strategic advice to the Minister of Health on the health and disability workforce.

2.What does the Medical Reference Group (MRG) do? MRG is a specialist reference group set up in 2003 to provide independent policy advice to the Health Workforce Advisory Committee on medical practitioner supply and demand, and on the education and deployment of doctors.

3.What is the purpose of this review of the medical workforce? The purpose of this review is to identify key medical workforce issues in New Zealand, encourage a greater understanding of these issues, and to develop a commitment to an agreed national health Workforce planning strategy.

4.What happens to the information received from submissions? Submissions received on the consultation document will be used to develop recommendations. The consultation document and recommendations will be sent to the Minister of Health.

5.What are the key findings? 1. Medical Workforce development must be placed in the wider context of the health service and health Workforce development 2. Traditional models of care and patterns of medical work must change through effective service and workforce redesign 3. major changes are required to the way in which medical education is organised and delivered in New Zealand

6.Why doesn't the review outline any possible solutions to the workforce issues identified? This is a consultation document, designed to outline key issues and encourage submissions from stakeholders in health and medical workforce development. Possible solutions and recommendations will be presented to the Minister of Health at the end of the submission process.

7. How many doctors are there in New Zealand per head of population and how does this compare to other countries? In 2002 there were 2.13 active medical practitioners / 1000 population in New Zealand. The inclusion of doctors holding temporary registration brings this figure up to 2.33 /1000 population. Comparisons are difficult to make for other countries, but estimations for 2002 have been made: Australia: 2.73/1000 UK 1.75/1000 Scotland 2.46 /1000

The Medical Council of New Zealand holds an annual workforce survey. Active medical practitioners are those who respond saying they work an average of over 4 hours per week. Doctors holding temporary registration are not included in the survey. 8.How many GPs are there per head of population? Again, international data on GP's per head of population are not directly comparable, but some assessments have been done: In 2003 New Zealand had 74.9 GP's / 100,000 population In 2003 the United Kingdom had 65.4 GP's per 100,000 population In 2002 Australia had 111 / 100,000 population

9.What proportion of overseas doctors make up New Zealand's medical workforce? In 2003 34.1% of fully registered doctors in New Zealand gained their undergraduate medical qualification from overseas. The inclusion of Temporary Registrants will bring this figure up to almost 40%. A temporary registrant is a doctor who graduated from a medical school and is visiting but not intending on residing permanently in New Zealand. They require supervision throughout their employment. Temporary registration is usually granted for two years.

10.How many medical students train in New Zealand and how does this compare to other countries? In 2004 New Zealand medical schools had 325 domestic students in their first year of medical studies - giving a student / population ratio of 8.1 / 100,000 As first year intakes have only recently increased, current medical graduate to population ratio is 7.1 / 100,000

Approximations have been made on enrolments in other countries compared to their populations: In 2001 the US enrolled 6 students per 100,000 population In 2001 England enrolled 7.7 students / 100,000 population In 2003 Canada enrolled 6.3 students / 100,000 population In 2004 Scotland enrolled 16 students / 100,000 population

In 2001 Australia had 6.2 medical graduates / 100,000 population

The document has raised questions about the length of time taken to train a medical practitioner compared to other countries, and the costs involved to both the student and the government throughout the under-graduate training process. The submission process requests feedback on these questions

11.Why doesn't New Zealand train more doctors? Restrictions on medical school entry in New Zealand began in the 1940's with the introduction of an annual 'cap' on funding for medical school positions. The initial cap was set at 100. Since then changes to the cap level have only been able to be made by New Zealand Government Cabinet decision. The last change to this cap took effect in 2004, when an additional 40 places were created for students from a rural background in New Zealand. The cap currently stands at 325.

12.What proportion of women make up New Zealand's medical workforce? In 2003, women comprised 34.5% of the medical workforce NB: women now comprise slightly in excess of 50% of medical student numbers

13.What proportion of men make up New Zealand's medical workforce? In 2003, men comprised 65.5% of the medical workforce

14.How many hours on average do doctors work in New Zealand and how does this compare to other countries? There is evidence to suggest that the hours worked by many medical practitioners are inconsistent with a healthy work-life balance. Over half of House Officers, Registrars and Specialists report themselves as working greater than 50 hours a week. Just over one third of General Practitioners and Medical Officers of Special Scale work less than 40 hours a week.

Medical workforce group % of group working >50 hours / week % of group working < 40 hours / week (i.e. part-time) GP's 30.6 35.1 House Officers 83.7 <5 Registrars 75.5 <5 Specialists 50.6 17.5 Medical Officer of Special Scale 19.8 37.6

15.How will New Zealand's aging population impact on the health workforce? We believe that the aging New Zealand population will drive the rate of demand for health and disability services into the future, due to increasing levels of chronic disease and consequent requirements for health care. This demand will increase more rapidly than the size of the population itself.

At the same time the labour workforce in New Zealand is expected to grow only slowly over the next 20 years, resulting in fewer workers aged 18-44 years, and many more workers aged 45-64 years. There will be high demand for younger members of the workforce.

16.How will the age of the medical workforce have an impact on the future needs of the health system? The medical workforce has aged progressively over the last decade, by 2003 23.3% of the medical workforce were under the age of 35, compared to 35% in 1990. There are a large number of medical practitioners in their early to mid-40's - due to the post-war 'baby boom' and temporarily increased admissions into medical schools between 1975 and 1980.

Without substantive change, this large cohort of medical practitioners will retire from the medical workforce in the next 20 years.

17.Are there any particular areas in New Zealand which have greater medical workforce issues than others? The consultation document identifies a number of immediate priorities for action: The primary health care / general practice workforce Undergraduate and post-graduate medical education Service and training requirements in secondary care facilities Recruitment and retention of the medical workforce The development of a systemic sector-wide approach to health and medical workforce planning and development.


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