Hundreds more GPs needed to meet demand on primary care
Wednesday, 21 August 2024
New Zealand is 485 GPs short, with this number expected to grow to more than 750 in the next decade. While the Government is looking to save $1.3 billion in health spending, GPs are leaving the sector fed up, overworked and burnt out. MARINÉ LOURENS looks at the reasons for the shortages as part of Fractures on the Frontline, a series examining the challenges facing general practice.
When Christchurch GP Pippa MacKay retired in 2023, she sold the practice she had owned for 36 years and left behind her 2400 enrolled patients.
The 69-year-old says she hated leaving her patients, but it was time. “I had owned my practice for 36 years, I'd worked my butt off.”
She says she didn’t want to be in her late 60s still working 10 to 12 hours a day (although that is what she ended up doing).
MacKay was “lucky” to sell her Ilam Medical Centre practice to a younger GP who could take over her large patient base. “I knew I was handing my patients on to somebody who was good and who would care for them - and they would like her.”
She says she had to work very long hours to care for so many patients, but she felt she had little choice.
“Periodically over the last 10 years or so I've closed my books, but I've always felt bad about it. Because Ilam Medical Centre was a big practice in an area where there's university students and there's a lot of young families, and being the only female in my practice, I felt under some obligation.”
MacKay is one of thousands of GPs who have either recently retired or plan to do so in the next decade.
The Royal New Zealand College of General Practitioners (RNZCGP) says there are about 5600 specialist general practitioners in New Zealand and - according to its 2022 workforce survey - nearly two-thirds of them plan to retire in the next 10 years.
New Zealand is 485 GPs short, with this number expected to grow to a shortage of between 753 and 1043 doctors in the next 10 years.
The General Practice Owners Association (GenPro) estimates 290,000 Kiwis are not enrolled with a general practice, and that “about half” of general practices have closed their books to new patients as doctors struggle to keep up with demand.
Despite the RNZCGP reporting that this year, a record number of 239 medical graduates started their three-year training programme to become general practitioners, New Zealand is still not training enough GPs.
A briefing to Health Minister Dr Shane Reti in January said more than 300 GPs needed to enter the training programme each year to replace those exiting and to keep pace with demographic change.
Even if we start training more medical students immediately, it will be years before the primary care sector reaps the benefits.
To become a GP, a medical student has to study for six years, do at least two years of postgraduate medical experience, complete a three-year general practice education programme run by RNZCGP, and pass a fellowship assessment.
Read more in the series** Fractures on the Frontline examining challenges facing general practice.**
Greener pastures
Meanwhile, an increasing number of both young and older doctors are leaving New Zealand because of current work conditions and the lure of better pay.
The RNZCGP 2022 workforce survey showed nearly 80% of respondents reported experiencing some level of burnout, with 48% saying they were burnt out.
Most locally trained doctors who are working overseas do so in Australia. This is unsurprising given Australia is our closest neighbour, the Australian health system recognises New Zealand qualifications, and there is much greater earning potential.
A 2019 comparison of medical specialist salaries showed New Zealand doctors earn on average about 60% of what their Australian counterparts earn.
Remuneration has been a burning topic in New Zealand healthcare for years, with this year marked by countless strike actions from various healthcare workers frustrated with low pay, lack of pay parity, and insufficient pay rises.
A shortage of nurses and the fact that nurses working in hospitals earn more than those in general practice are placing further strain on the primary sector.
A nurse team leader at a general practice in Otago, who did not want to be named on request from her employer, said she feared what would happen if one member in her team of four left, as she didn’t think they could be replaced.
She says over the past couple of years they have advertised for nurses and only received applications from applicants living overseas. Years ago it wouldn’t have been unusual to have job-searching nurses drop off their CV at reception, but that hasn’t happened in years, she says.
“We’ve had situations where for months we had no applications for [nursing] positions.”
She said the nurses in her team could all get work in hospitals and earn almost $8 an hour more. “I wouldn’t blame them, that is $320 a week more for a full-time worker.”
Workforce ‘the biggest issue in health’
When The Post interviewed Reti in early August, he said the workforce was “the single biggest issue in health”.
“I stand by the statement that I can build this and build that, but if I can’t staff it, it kind of doesn’t matter.”
When asked how strengthening the workforce ties in with his appointment of commissioner Lester Levy, who has said he would possibly need to cut 2500-3000 jobs from the sector, Reti said New Zealand finds itself in “a position of failed implementation”.
“[This] has led to fiscal unsustainability, which means I've needed to appoint a commissioner so that we can reprioritise savings so that we can better support the front line.”
Reti said he has made it “very clear” that the front line must not be affected.
MacKay said she found it difficult to understand how the Government could justify paying nurses in primary care less than those working in hospitals. “What is different about being in primary care, why would you not pay the same? There should be no difference […] otherwise, not surprisingly, you get a flight of nurses into the place where they can make the most money.”
As for GPs, MacKay said New Zealand had to train more doctors, make general practice a more attractive option for medical students, and make the country an appealing place to work.
Porirua GP and chairperson of General Practice New Zealand (GPNZ) Dr Bryan Betty said in the late 80s and early 90s, about 50% of medical graduates indicated they wanted to go into general practice. Today that has fallen to 15%.
“That is a major issue for the system, because we're totally reliant on the general practice sector for the delivery of medical care, it is 96% what goes on,” he says.
“We’ve got to have a robust pipeline of GPs coming through, and that requires two things: It has to be an attractive place to work, and it has to be financially sustainable.”
MacKay thinks general practice has become less appealing due to a combination of factors including the difficult working conditions and lower pay. “[They are] coming out of med school with over $100,000 debt and then [expected] to go into a discipline that pays them less well.”
MacKay said she had made a good income from her practice, but she had worked “exceedingly hard”.
An article published in the New Zealand Medical Journal in March said out of the OECD countries, New Zealand has the second-highest dependency on overseas-trained doctors with international medical graduates making up 42% of the workforce.
But international graduates only offered a short-term solution. “Overseas-trained doctors are less likely to remain in the country compared with New Zealand doctors. Currently, around 60% of international medical graduates leave within two years of registration, with significant costs to the New Zealand health system.”
MacKay said she agreed with interim chairperson of General Practitioners Aotearoa Dr Buzz Burrell’s warning that the health system could collapse completely within two years if primary care wasn’t given more funding and support.
“Lester Levy is not a magician, he is a cost-cutter,” she said.
“His mission is to cut $1.3 billion, that’s what he has been tasked with. I don’t think he will succeed, but I am very concerned about what will happen in public healthcare in the meantime […] as they slash and cut.”