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Numbers crisis ahead for general practice

Numbers crisis ahead for general practice

The combination of an ageing GP workforce and the failure of successive Governments to train enough new GPs paints an alarming future for primary health care in New Zealand.

“Take parallel figures on New Zealand’s population ageing, overlay the GP figures, and we’re looking at a workforce in crisis,” said College of GPs president Dr Jonathan Fox.

Dr Fox said other health professionals were reporting the same disturbing trends.

“At a time we’re being asked to work smarter and change to incorporate new strategies from the Government, our members are reporting rising stress levels and extra hours just to deal with the bureaucracy and compliance demands.”

“We need action now,” Dr Fox said. “It takes at least 12 years to train a top GP.”

The Royal New Zealand College of General Practitioners today released figures showing the mean age of GPs has aged six years in the last eight years. In 1998, it was 42, today 48.

The survey, sent to all members of the College, had a response rate of 60 percent (2057 members), with a margin of error of ± 1.35 percent at the 95 percent confidence interval.

“Thirty-seven percent of the workforce is over 50, with a further 10 percent over 60,”
Dr Fox said. The ageing trend is accelerating. In 1998 40.8 percent of GPs were under 40, this year just 18.7 percent are under 40.

“That’s 71 percent of GPs aged 41 to 60.”

This release is the first of four thematic papers, presenting the findings of the 2005 survey. This particular paper focuses on the demographics and working arrangements of the College’s GP membership. Subsequent papers in the series highlight other significant issues affecting the GP workforce, working conditions and remuneration, future intentions and rural general practice.

The survey reveals a stressed and diminishing general practice workforce ageing faster than it is being replenished; GPs perceive themselves as increasingly bogged down by bureaucracy and compliance requirements.

New Zealand is already heavily reliant on Overseas Trained Doctors, at 34 percent, well ahead of the next comparable country, the United Kingdom at 28 percent.

“New Zealand has to compete in a global market for our medical workforce,” Dr Fox said, “yet we still place funding barriers against training enough of our own graduates.” In the last two years the College has received more than double the number of applications for the 54 funded places on its high-quality training programme. Scholarships aimed at incentivising Maori and Pacific Island doctors into general practice were stopped by Government last year.

“Maori and Pacific Island populations suffer an increasing health risk, yet these populations are proportionately under-represented in the GP workforce.

Despite increasing numbers of young GPs accepting only locum or salaried positions, 56 percent of College members remain self-employed.

“Older self-employed GPs also work the longest hours,” Dr Fox said.

On average male GPs work 54.8 hours per week (1.4 Fulltime equivalents), with female GPs working 38.9 (.97 FTEs). GPs in the 46-65 cohort spent more time each week in general practice, with increasing administration and compliance time.

The Health Workforce Advisory Committee has already recognised the significant implications of a predominance of women in the whole medical workforce. GP figures also follow this trend, with more females working as locums or part-time salaried GPs.

The population of New Zealand is growing ageing and becoming more ethnically diverse. Based on current assessment of health need these changes will impact directly on primary care and the work of general practitioners.

Over 65s are heavy users of primary care and anecdotal evidence suggests they present with complex issues that will involve longer consultations. Already some practices report more than 60 percent of their enrolled populations are over 65.

“We must reverse this trend now,” Jonathan Fox said, “or in 10 years the problem may be insoluble.”

RNZCGP Report (pdf)

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