How Wellington lost its last gynae-oncologist: 'I had pretty much every symptom of burnout'
Saturday, 18 April 2026
Amanda Tristram was the only gynae-oncologist left propping up Wellington’s specialist women’s cancer surgery unit. She hung on thinking it would get better, in the hope of saving the service. But it never did, she tells Nikki Macdonald.
The waking dread of going to the job she once loved lifted soon after Amanda Tristram quit as Wellington’s last remaining gynae-oncologist. But the burnt-in burden of years doing the work of three people was harder to shake.
“Burnout is interesting … It takes way longer than you think,” the 60-year-old says. ”That background anxiety probably took the best part of a year to go.”
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She’s spent that year relaxing with friends and family in Britain, where she’s from, and working as a volunteer DOC hut warden on Quail Island in Lyttelton Harbour.
When she resigned from the job in November 2024, she didn’t know if it was just a brain-break, or early retirement from a health system that still desperately needs her. Now, she’s sure.
“I don’t think I would go back into medicine now. I’ve resigned from the college, and I’ve left the medical register. It is hard, because it is something I’m still so passionate about.”
The road to Wellington
In 2016, Tristram was working as a women’s cancer surgery specialist, or gynae-oncologist, and researcher in Cardiff, when she got a job email from a recruiter. Usually, they were a quick flick: obstetrician in Kuwait - delete; gynaecologist in Dubai - delete. But this one held her interest.
While sailing in the BT Global Challenge round-the-world yacht race in 96/97, she’d spent six weeks in Wellington and loved it. Plans to return never materialised, but here was her chance - a gynae-oncologist position in Wellington.
“I thought, that’s just my perfect job.”
So she applied, and moved across the world. When she arrived, she had 1½ colleagues - a gynae-oncologist just finishing her specialist training, and a part-time gynaecology consultant.
But within about six months, the newly minted specialist left for Auckland, beginning an eight-year struggle to recruit and retain the three specialists the capital should have to provide complex surgery for the population of a million stretching from Taranaki and Hawke’s Bay south.
With 2½ specialists it was “really hard work”, but manageable, Tristram says. Having worked in a team of consultants in Wales, she had become super-specialised, treating mostly vulval cancers.
She enjoyed the Wellington role’s greater variety. And the people were fantastic.
“I really enjoyed the challenge. I love the job.”
The unit got a new recruit from overseas, but he ended up going on extended leave. And then the part-time consultant retired in August 2022. Suddenly, Tristram was on her own.
“It just got crazy … I was covering a million population by myself, which should have three people.”
Christchurch surgeons had to fly up so she could take leave.
“If I was ever away, I'd be getting phone calls for advice back in the UK, at four o'clock in the morning. It just never stopped. It really was 24 hours a day.'
Tristram kept thinking things would get better. She recruited Elaine White from Hawke’s Bay, a fellow Brit obstetrician and gynaecologist who had a kind of halfway gynae-oncology qualification. That meant she could take some of the load, but not all of it.
But despite having supervised gynae-oncologist training in Britain, Tristram couldn’t train White to be a full specialist, because while the Medical Council accepts her UK credentials as qualification to work here, the College of Obstetricians and Gynaecologists doesn’t accept it as evidence she can train others. That’s something she wants changed.
So Tristram pinned her hopes for saving Wellington’s specialist service on two trainees waiting in the wings. But because she couldn’t train them, they had to go to one of the country’s two other gynae-oncology specialty centres - Auckland or Christchurch - to get qualified.
“When I discovered that one had been given a job in Auckland and one in Christchurch for the end of their training, that was one of the final nails in the coffin.
“Because that was like, what am I doing here then? It’s not going to get any better. I’ve been trying to keep this service together so that they could come and do it.
“Also, by this stage, I had pretty much every symptom of burnout going. I wasn't sleeping. I was waking up dreading going into work … I could feel myself getting irritated and frustrated, and I didn't want to snap.
“As I said to my manager when I handed my notice in, I want to leave while I can still have a leaving do.”
What’s the plan?
Tristram’s departure killed off the Wellington specialist service, with Health NZ saying it has no plans to recruit gynae-oncologists to the capital for at least four to five years.
Women with less complex gynaecological cancers can still be operated on in Wellington, with support from Christchurch surgeons who fly up once a month for a week.
But lower North Island women with complex cancers, such as advanced ovarian cancer, now have to fly to Christchurch for surgery. From November 20, 2024, to January 21, 2026, 106 women had to make the trip south.
Tristram knows how hard it is to go to an unfamiliar place when you’re already dealing with a devastating diagnosis - that’s why they set up outreach clinics so Hawke’s Bay and Taranaki patients didn’t have to drive to Wellington.
“They might never have been to Wellington before. They've had to get up at four o'clock in the morning to drive down for clinic, then they’ve gone the wrong way down a one-way street. They can't find anywhere to park the car, and we keep them waiting in the waiting room. By the time they come in to see you, they're not in a state to take in any information.”
New Zealand has just 10 specialist gynae-oncologists to treat the cancers that make up one in 10 female cancer cases - and one in 10 deaths. Five are in Auckland and five in Christchurch, one of whom is working half-time.
That’s just two-thirds of the 15-16 specialists that experts have previously said New Zealand needs. Demand is likely to increase, as womb cancer rates are soaring.
Tristram believes a Wellington gynae-oncology specialist service is still “absolutely, totally a goer”. But only as part of a national plan, with consistent pay, and trainee placements based on which area needs them most.
With only one of the past eight trainees staying in New Zealand, the country’s three specialist units have had to compete for staff in a fight for survival.
“This needs to be done nationally, and the three centres work together, rather than this constant battle for resources,” Tristram says. “Using women as pawns in a political game is completely out of order.”
Freshly qualified specialists could be supported in Wellington by Christchurch and Auckland consultants on a fortnightly rotation, which would still be less onerous for those doctors than the current scheme of flying Christchurch surgeons in monthly, Tristram suggests.
Complex cases could also be discussed in national planning meetings, as happens in Scotland, she says.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) NZ vice-president, Emma Jackson, also questions the sustainability of the current setup.
Expecting the “stretched” Christchurch team to cover the entire South Island and lower North Island patients risks reducing access to gynaecology treatment in Christchurch, Jackson says.
“We believe this team requires additional resourcing and support to be able to sustain this care, and that gynae-oncology services nationally are under-staffed.
“With growing rates of gynaecological cancers (particularly endometrial cancer) there is an urgent need for future workforce planning, as well as investment in prevention.”
Jackson says Health NZ has been developing a long-term plan for gynae-oncology services since late 2024, but the college understands progress has stalled.
Any planning also needs to make New Zealand positions more attractive in a global market that offers higher pay, more research opportunities and better work conditions, Jackson says.
“There is a very competitive market and active head-hunting for gynae-oncologists internationally, which makes both recruitment and retention hard.”
In response to Tristram’s criticism of her inability to supervise trainee specialists, Jackson says the college is working on a new certification system so internationally qualified gynae-oncologists can play a more significant role in training.
Health New Zealand’s director of hospital funding, Rachel Haggerty, says a nationwide plan is underway for specialist gynae-oncology services, and should be finished by the end of September.
The plan will “develop an implementation pathway that sets the service up for success”, she says.
“It will identify what service capacity is required to address the need for this service in the coming years, make recommendations about how many centres are required and how we transition from the current state to one that will continue to serve New Zealanders in a clinically sustainable way.“
In October, Health NZ told The Post it was working to identify what resources were needed to support Christchurch’s extra workload, such as additional anaesthetists and pathologists. Asked what support has been added in the six months since, Haggerty now says that will be included in the national plan.
Back in Wellington, Tristram doesn’t wish she’d never answered that Wellington job ad, although she thinks it was probably career suicide.
“I don't regret coming. Do I find it easy when people in the UK ask me, would you recommend going to New Zealand? No, I find that very difficult to answer.”