Recruiting reveals NZ specialist crisis

Delays in recruiting anaesthetists to allow extra acute surgery at Dunedin Hospital illustrates the country's continuing specialist workforce crisis, Associated Salaried Medical Specialists executive director Ian Powell says.

It was a situation that people could expect to see around the country, with different types of specialists, until there was national responsibility for recruiting and retaining senior doctors, he said.

Mr Powell was commenting on yesterday's Otago Daily Times article that explained the extra 35 hours a week of acute theatre time at Dunedin Hospital had been delayed until March when it had previously been hoped it would go ahead in November.

Recruitment of staff, including anaesthetists, was the issue.

Mr Powell said anaesthesia was not the only specialty where extra staff were needed, but the absence of anaesthetists was particularly critical for surgical specialties.

Boards could hire as many orthopaedic surgeons as they liked, but they were "helpless" without anaesthetists.

In a comparison between specialist requirements in New Zealand and Australia, based on 2008 figures, it was estimated New Zealand needed 106 more anaesthetists to reach the level of coverage provided in Australia.

Mr Powell said he was concerned about the lack of direction on the whole issue of retaining senior doctors.

He felt Health Workforce New Zealand, which should have been doing this work, "had lost the plot", and he questioned whether a pilot scheme of physician assistant at Middlemore Hospital had been given too much attention at the expense of looking at ways to retain existing specialties.

What was needed in New Zealand was a balance between sub-specialist and generalist training and that was one of the themes in the association's business case developed with the district health boards, "Securing a sustainable senior medical and dental workforce in New Zealand".

Disagreements over the status of that document developed earlier this year when the district health boards said the proposed spending of an extra $360 million on salaries over three years was not possible.

In Dunedin, intensive care specialist, general surgeon and a member of Dunedin Hospital's "Putting the Patient First" governance group, Mike Hunter, is promoting discussion of whether there is a need to change the mix of training at the hospital, introducing more general trainees.

He believed the hospital could provide a unique blend of generalist and sub-specialty expertise, offering the best of both.

When a large number of sub-specialties was offered at a hospital the size of Dunedin Hospital, it became much harder to provide care around the clock, because so many people needed to be on call.

Smaller provincial hospitals such as Southland, Timaru and Palmerston North, which provided more general models of care, found it easier to provide cover.

Mr Hunter said no-one was suggesting that the hospital should give up sub-specialties, but he was asking people to consider whether there was a need for a more general acute admitting service.

This could call in specialists for particular procedures or allow consultation the next day, depending on the condition of the patient.

On the training issue, he was hopeful Health Workforce New Zealand could give a lead, as there needed to be a national approach.

He considered there had been a disconnection between the professional colleges, which generally covered Australia and New Zealand, and the Ministry of Health and district health boards, and the nuances of New Zealand's needs had been lost.

Some of the discussion had been "a bit directionless" and concentrated on groups of specialists dominated by the Australian sections of colleges who saw the need to train "more people like them" rather than take a full view of health-professional needs around New Zealand.

elspeth.mclean@odt.co.nz