When medical help is 100km away
Physicians sound alarm over staff shortages and remote rural access, Isaac Davison writes.
New Zealand’s shortage of medical specialists is so severe that people in some regions have to travel 100km to see a paediatrician. The shortages are worst in the South Island’s West Coast — with one physician for the whole region and no paediatricians — and the Bay of Plenty.
There were widespread gaps before Covid-19, with an average 24 per cent shortage of medical specialists nationwide. But that has now grown to 40 per cent in some areas, according to the Royal Australasian College of Physicians.
And the shortfalls — including oncologists, dermatologists and other roles — are contributing to growing waitlists.
While there are improvements in some areas, Te Whatu Ora’s latest data showed the number of patients waiting more than a year for treatment was growing in 14 out of 20 districts, and cancer treatment wait times were growing in 12 of those districts.
The royal college has challenged all parties about their plans to address shortages and other key issues.
“Access to consistent high-quality hospital and specialist services is vital to keeping all New Zealanders well and should be available irrespective of where people live,” the college said in a statement sent to all main parties.
The royal college, which represents around 3000 doctors, has outlined four priority areas:
Better data on where the workforce gaps are and a strategy to fill them
Growing the workforce to reflect the diversity of the population Removing barriers to telehealth Preventing burnout to retain workforce and improve patient outcomes
A Government stocktake released in July found that New Zealand would need 5000 more doctors and 13,000 more nurses over the next decade.
President of the college’s New Zealand chapter Dr Stephen Inns said, however, there was limited understanding of which specialists were needed and each region’s level of need.
Once Government had a detailed picture of the gaps, it could make
I don’t think we’re saying the West Coast needs three or four physicians, we have to be able to say that this population has these needs and we want to provide this much support and it will take this much time. As a nation we haven’t yet got to that point. — Dr Stephen Inns,
informed decisions on how to address them, he said.
“I don’t think we’re saying the West Coast needs three or four physicians, we have to be able to say that this population has these needs and we want to provide this much support and it will take this much time. As a nation we haven’t yet got to that point.”
In some remote areas, it may be impossible to get more doctors on the ground, so the college is seeking expansion of telehealth services — and infrastructure improvements to allow this.
One of the main goals of the Government’s flagship health reforms is to reduce the “postcode lottery” in which care varies by region. The college said the lottery was still “alive and well” in New Zealand.
Health Minister Dr Ayesha Verrall said progress was being made in this area.
The first step was a new national threshold for cataract surgery, which meant equal access for patients no matter where they lived. This would be used as a model to improve other waitlists in future.
“We estimate there will be 3500 more surgeries as a result, and it’s our first step in what we can expect to see across elective surgeries from now on,” Verrall said.
Verrall was supportive of expanding telehealth, and said a procurement process had begun for a rural telehealth service.
On the issue of retention, Verrall cited Labour’s plans to lift graduate numbers by 335 from 2027, create a new support service for junior doctors, lift international recruitment and increase pay for staff.
National’s health spokesman Dr Shane Reti said New Zealand could not compete with Australian wages and needed to focus on how working conditions could be made more attractive.
Flexible workplaces and better management of workloads would be key to retaining senior doctors, he said.
“How do we better reflect that it is primarily a women’s workforce? Are there better ways around more flexible hours for women who are mothers and have families and childcare?”
RACP found that in some speciality areas, like dermatology, the public workforce had shrunk so much that it was difficult to find training places, which in turn led to fewer trainees to grow the workforce.
The college has increasingly encouraged flexible training, in which doctors can train part-time, take a break, or withdraw from training.
Reti said he broadly agreed with the college’s wishlist. Growing the workforce would be his top priority if he was minister, he said, and the profession needed to reflect New Zealand’s diversity.
He supported the expansion of telehealth and would be interested to see the review of the Government’s winter health plan, which would provide more detail on whether virtual medicine was accessible and costeffective.