Entrenched public hospital specialist shortages unsafe
“Entrenched public hospital specialist shortages becoming increasingly unsafe”
“Many public hospitals will need to reduce services in the near future as a result of continuing shortages of medical specialists,” said Mr Ian Powell, Executive Director of the Association of Salaried Medical Specialists, today.
Mr Powell’s warning comes with the release of a comprehensive report by the Association on key issues concerning the demand and supply of specialists in New Zealand public hospitals. “The report’s conclusions are based on the best health intelligence available.”
“Specialist shortages, which have existed for many years in many areas, have become so entrenched that the resulting sub-standard conditions have become the ‘norm’. Public hospitals are not retaining enough of the specialists we train, are not recruiting enough specialists to fill the gap, and are not retaining many of those we do actually manage to recruit.”
“As a result, hospital specialists are caught between the proverbial rock and hard place. On one side they have increasing clinical workloads. On the other there is mounting pressure to spend more time supervising and training resident (junior) doctors, and engaging in clinical leadership activities.”
“Up until now services have been held together by specialists giving priority to meeting patients’ clinical needs at the expense of their supervising, training and leadership roles. But that situation is becoming increasingly unsafe, it is limiting the training and experience of our future specialists, it is hugely wasteful, and is contributing to a high turnover of both resident (junior) doctors and specialists.”
“This assessment is based on government documents, published research and the most recent workforce data from the Medical Council of New Zealand and District Health Boards.”
“Unless there is an urgent quantum leap towards addressing our retention crisis, we are approaching the point where there is no option but to cut clinical services,” concluded Mr Powell.
Q&A: ENTRENCHED SPECIALIST SHORTAGES IN NEW ZEALAND PUBLIC HOSPITALS
Why was this report produced?
In late 2010, in response to acknowledged specialist workforce shortages, the DHBs and ASMS jointly developed a Business Case with the aim of securing a safe and sustainable specialist workforce in district health boards. The document outlined how continuing shortages posed serious risks for the public health system, including standards of patient care and financial waste, and set out actions to address the crisis.
Those actions have not been implemented, and the sky is still intact, which raised the question as to whether the situation between then and now had changed to the extent that the crisis had been averted. This paper reviews the issues raised in the Business Case and pulls together the latest data and research to answer that question.
What is the main finding?
The situation in 2010 that the Health Minister himself described as a crisis remains unchanged in 2013. There are strong indications of entrenched shortages across a wide range of specialties.
• More specialists are entering the workforce but well short of the numbers needed – and agreed with DHBs – to enable safe and sustainable services.
• Retention of our new specialists and potential future specialists is getting worse, especially among international medical graduate doctors (primary medical qualification obtained overseas).
• On current trends, in the next five years nearly 20% of the specialist workforce could be lost due to a drop-off of doctors from the age of 55.
What are the effects of entrenched shortages?
The shortages impact on quality and safety and are financially wasteful. Increased clinical workloads, especially to meet health targets, have coincided with increased hospital readmissions. Specialists are unable to find adequate time for supervising and training resident doctors. There are indications this contributes to adverse events costing up to $800 million each year. Services are heavily dependent on expensive locum positions (temporary doctors). The ability to build a health service to meet future needs is severely limited because specialists lack the time to develop more innovative service models.
Is the Government taking any action to address the crisis now?
Health Workforce New Zealand, which is responsible for the planning and development of the health workforce, is overseeing a number of activities aimed at mitigating medical workforce shortages. They include bonding schemes for resident doctors and the development of new models of service, including attempts to reduce the workloads of specialists by extending the roles of other health professionals into specialist practice. Local and international evidence suggests the effectiveness of such approaches is variable and at best might have only a marginal effect on alleviating specialists’ workloads.
What needs to happen?
Urgent investment is needed to address the retention crisis (and consequentially recruitment) to enable public hospital specialists to have adequate time to fulfil vital non-clinical duties, especially in supervising and training resident doctors, and engaging in clinical leadership activities. Non-clinical duties are important for improving quality and safety, and medical workforce retention. Clinical leadership activities are important for improving the effectiveness and efficiency of hospital services and for better managing the increasing costs of services. Overseas evidence points to potential “savings” of hundreds of millions of dollars.
Medical Specialist Workforce Numbers
The Government says there are now more doctors than ever practising in New Zealand. How do the findings of the report reconcile with that?
The number of doctors must continue to grow to meet the needs of a growing and ageing population. We would almost certainly be unique among developed countries if our medical workforce did not grow. In 2010 the DHBs agreed on a minimum annual increase of nearly 210 specialists until 2021 in order to ensure a safe and sustainable workforce.
By how much did the specialist workforce grow between November 2008 and April 2012?
According to the Government’s figures, the DHB workforce increased by 473 full-time equivalent (FTE) specialists between November 2008 and April 2012. (Their figures to September 2012 are not yet publicly available.) That’s an average annual increase of approximately 135 specialists – 75 short of what the DHBs had acknowledged, in 2010, was needed. The deficit grows each year. DHB headcount figures, used in this report, indicate an average annual increase of approximately 130 specialists over the four years to June 2012. What New Zealand needs is for the number of public hospital specialists to grown by 210 annually.