Jay Querian
It is common knowledge that New Zealand has a medical workforce crisis. But how did this come about?
Politicians may hurl insults at each other and assign blame, but the truth is that today’s crisis has been brewing for 50 years, through numerous changes of government. The American Indians used to say that when you point a finger at others, remember that there are three fingers are pointing back at you. This is perfectly true when reviewing the current state of the healthcare system.
Back in the 1980s, we had medical professors and specialist colleges warning that New Zealand was not training enough doctors to match projected demographic changes – and that was before the waves of mass migration began.
At first New Zealand got away with it, because thousands of doctors with equivalent overseas medical degrees were keen to emigrate and practise here. Administrators congratulated themselves for an expert workforce increasingly trained at somebody else’s expense. Many communities benefitted from doctors from the other side of the world and who brought their families and settled into local communities to became Kiwis. As the decades passed, small incremental increases were made to local training, while New Zealand became increasingly reliant on immigrant doctors.
In the most recent figures from 2024, there are almost exactly 20,000 practising doctors in New Zealand, of whom 43 per cent or 8,600 have an overseas qualification. Even with a new medical school now announced for the Waikato, readers can do the math to confirm that it will be decades before extra local trainees will make any difference compared to the enormous international workforce. New Zealand is entirely reliant on immigrant medics – and we should look after them because without them we would not have a functioning healthcare system.
But something else appears to have changed. In the most recent Medical Council workforce statistics, local doctors still have very high retention rates out to 10 years, but overseas doctors do not. These days, when overseas doctors commence practising in New Zealand, over half of them have already moved on within two years.
The figures are worse for doctors from the First World. If 10 doctors arrive from North America, after the first year only three are still practising here. After two years, only two still here. UK and even Australian doctors are not far behind. Only doctors from the Third World are likely to be practising in NZ for more than two years.
We can all speculate on reasons why overseas doctors leave so quickly. Better pay across the ditch is a common explanation. Another is that relaxed entry criteria make us a springboard for doctors who leave as soon as they get NZ credentials allowing entry into Australia.
However, consider that First World doctors knew they were taking a pay hit when they decided to emigrate to New Zealand. And still they came. So why would we believe that money causes them to leave again? Why not head straight for Australia if they want the money and have an acceptable collegiate degree? Neither of the above theories can explain why First World doctors leave more quickly than Third World doctors.
In my private capacity I have been privileged to ask some doctors why they are leaving. Of course, money is part of it. But I would suggest that when a doctor gives up on New Zealand, better pay just a short plane flight away makes it easy to attribute the exit to money. This is a safe explanation when departing a system that can show viciousness when crossed.
Quietly, reference may be made to medical autonomy that apparently is much reduced in an authoritarian New Zealand that no longer sees doctors as patient advocates. Others refer to ‘chaos’ in an overwhelmed system that never has enough resources and lurches from crisis to crisis. Some years back there was a very well-regarded overseas consultant who only survived 26 days in an urban NZ hospital before fleeing in dismay at the workload and patient attitudes she encountered.
Even schooling can be a contributor, with immigrant kids sometimes appalled at classrooms dominated by rowdy ill-disciplined kids who regularly disrupt class or a classmate who is a notorious biter.
When you see the Medical Council speculating that perhaps North American doctors leave so soon because they might be on working holidays, you realise that there are no good statistics on why doctors leave. There is some data, but it is fragmented and often collected by stakeholders with vested interests or who may be part of the problem.
Whatever the cause, if fewer than half of international recruits can be expected to stick around, it makes little sense to focus on increasing recruitment to solve the crisis, as if pouring more water into a leaky bucket will overcome the leaks.
Surely, we need a sympathetic exit interview process to make sure we know why doctors keep leaving. However, the usual New Zealand instinct to compel answers rather than seeking co-operation will not succeed once a doctor is resolved to leave. If bullied, departing doctors will simply declare that they are leaving for the money, so any opportunity for improvement will be lost. This logic disqualifies the Medical Council and even specialist colleges that often have their own agendas.
I would recommend calling on respected retired professors and GP leaders of old to provide one last public service to help to determine why so many doctors are leaving. Departing doctors are more likely to appreciate collegiate courtesy and have nothing to fear from independent respected colleagues, making it safer to answer honestly and anonymously.
Available data already reveal that, when you ask, things that ‘everybody knows’ about doctors often turn out not to be so. As an example, latest figures confirm that women now outnumber men in medicine, but women work fewer hours, with over 60 per cent of female doctors working part time.
We may think we know why female doctors end up working part time but, to its credit, the Medical Council asked anyway and published the answers: in 2024 the majority of female part-timers gave ‘personal preference’ as their reason. Only 20 per cent of women quoted family obligations, which I had been sure would be the main explanation. This creates an opportunity: if five part-time doctors can be incentivised to change their ‘personal preference’ and work an extra day, effectively you have an extra doctor.
This is what happens when you ask. It illustrates the marvellous power of the scientific process to improve understanding and correct error. We must challenge the status quo, no matter how certain we are of ourselves.
Another example: if it does turn out that doctors are using NZ’s more relaxed entry criteria to springboard into Australia, recent proposals to reduce entry standards even further seem unlikely to help solve New Zealand’s crisis. Do we really need to find this out the hard way?
The political party that seems most interested in investigating these matters is New Zealand First and they even had this topic as a remit at their recent convention. Unfortunately, if this idea is taken up by some other party, the instinct will be to gift it to one of the usual Wellington chums who can be relied upon not to rock the boat. If this happens you will get the answer that it’s all about the money and before long politicians will be proposing to foist lesser-qualified professionals onto Kiwis as doctors continue to quit.
There are other issues and developments that deserve consideration. The UK experience with insufficient specialist medical trainee applicants in the early 2000s, followed by massive oversubscription now, provides lessons that New Zealand ought to heed, rather than repeating the same mistakes. There’s also the rise of an enormous middle class in India. These people are very health conscious, creating lucrative opportunities at home for doctors from reputable Indian universities who once might have emigrated to New Zealand. And of course there’s demographic changes, with urgent needs of today’s large boomer population likely to reduce after we depart this mortal coil. I will address these topics in a later essay.
