Briefing: Senior Doctor Collective Negotiations
THE ASSOCIATION OF SALARIED MEDICAL SPECIALISTS
A S M S
NO: 08-1 8 February 2008
WHAT’S BEHIND SENIOR DOCTOR COLLECTIVE AGREEMENT NEGOTIATIONS?
WORKFORCE CRISIS: PENDING INDUSTRIAL ACTION
The ASMS represents salaried senior doctors and dentists most of whom are employed by DHBs. We are currently re-negotiating the senior doctor national collective agreement (MECA, multi-employer collective agreement) which expired on 30 June 2006.
It is important to understand the context for this lengthy and acrimonious dispute (negotiations commenced in May 2006). It included the unprecedented very well attended national stopwork meetings held last July-August and last November’s also unprecedented national ballot in which 88% voted for industrial action. Negotiations resume on 11-12 February. If the impasse continues then it is most likely that the ASMS National Executive will approve the formal initiation of industrial action at its next meeting on 21 February.
What sits in the background of this impasse is a crisis of retention and recruitment of the senior doctor workforce in New Zealand which is nearly at a “tipping point”. The major cause is now the enormous gap in base salaries between New Zealand and Australia which is a recent development.
These increases are in response to Australia’s own critical medical workforce shortages.
This crisis presents as:
* the loss of senior doctors (including some key clinical and professional leaders) such as the example featured in the NZ Herald today;
* our failure to compete in recruiting international medical graduates;
* the loss of trainee specialists (in surgery and diagnostic specialties), and
* more specialists moving into the private sector (in specialities like surgery).
Why the crisis?
In broad terms there have been two outcomes in Australia. The smaller increases have been in the two most populous states of New South Wales and Victoria leading to outcomes in which the minimum base salary steps are around AUD50,000 ahead of New Zealand’s comparable steps. The larger increases have been in other states, particularly Queensland and Western Australia leading to outcomes in which the minimum base salary steps are around AUD100,000 ahead of New Zealand’s comparable steps. Other conditions such as superannuation and support for professional development and education are also far superior.
Australia is significant (more so than, for example, Britain, western Europe or North America) because of the ‘tyranny of proximity’ (relative ease of maintaining contact with family and whanau in New Zealand) and the commonality of our medical training systems. The Australian threat to New Zealand is two-fold—recruiting doctors from New Zealand across the Tasman and competing against New Zealand for international medical graduates from other parts of the world (both countries have a high dependence on overseas recruitment).
Another contributing factor is the increase of elective surgery in the private sector in New Zealand, in part created by contracting out, which is enhancing full-time employment options in some specialities, predominantly surgical and diagnostic. In previous years full-time private employment even in these specialties was uncommon; this is increasingly no longer the case.
The workforce crisis for DHB employed doctors is most pronounced in provincial DHBs and in smaller services in urban DHBs. But even our largest secondary/ tertiary DHB (Auckland) with all the advantages of a major medical school failed despite determined efforts to recruit to new radiologist positions.
Impact of the crisis
In broad terms the crisis is evidencing itself in four main areas.
1. Loss of senior doctors to Australia. A survey we conducted last year confirmed that over 80 senior doctors had resigned in order to work in Australia during the 18 months between 1 January 2006 and 30 June 2007; in other words, around one a week. The effect is devastating on specific services given, due to our small critical mass and the size of many of our services. It appears that the rate of these losses is increasing. It is worth noting that Australia could recruit all New Zealand’s senior doctors and still not fill its vacant positions.
2. New Zealand is simply unable to effectively compete against Australia for the international medical graduates that both countries depend on recruiting.
When one country is offering terms and conditions between 50% and 100% more than the other, the implications are selfevident.
3. New Zealand is losing ‘trainee specialists’ (at the completion of their registrar training) to Australia attracted by the superior terms and conditions being offered. They are unlikely to return to New Zealand because of the ‘tyranny of proximity’. We are also losing other resident doctors as well.
4. According to a survey conducted by the College of Surgeons, around 17% of surgeons now work full-time in the private sector. This includes a number of surgeons who go straight to the private sector after achieving specialist registration rather than even working part-time for DHBs. Although there is a lack of comparative data, the consensus is that this is a significant shift of direction.
In a frank discussion on the medical workforce the Medical Council News of November 2007 includes the observation that less than 50% of international medical graduates remain in New Zealand one year after they are registered. The overall conclusion of Council Chairperson Professor John Campbell about the state of the medical workforce was: We are dealing with serious medical workforce shortages in several different specialties and areas. We are not producing the number of doctors we need ourselves, we are not retaining enough of those we do train and we are not retaining a high enough proportion of international graduates who come to practise in New Zealand.