There has been much recent publicity concerning Aotearoa-New Zealand’s need for more medical professionals of all types, especially nurses and doctors. That begs the question of what a good medical professional is, and how we can attract them to work in our lovely country.
Requirements of medical graduates have been defined in the Hippocratic Oath since antiquity. Modern times have required modifications of that ancient document. Besides technical knowledge and ability, the modern health professional who practises clinical medicine has to know how to deal with people and be capable of demonstrating personal qualities such as compassion, patience, communication skills, teamwork and generosity of time and self. They also need to care for themselves. The Medical Council of New Zealand has the challenging task of ensuring adequate training, experience and personal suitability of foreign graduates in a timely manner before they are registered in New Zealand.
People enter healthcare professions for many reasons. These vary from contributing to the needs of the community to having a good job that generally provides security and generous remuneration; both are important, but neither is sufficient on its own. Many of us who trained overseas and migrated to New Zealand did not do it for the money; in the 1970s salaries were very modest, especially when compared with those offered in many other countries. We were drawn to a beautiful and peaceful country where we could practise medicine in a reasonably equipped and sophisticated environment. Some of us interested in research were provided with good facilities in places such as Dunedin, where teamwork readily included other scientific sub-disciplines.
An environment which produces a supportive and productive working environment is regarded as more important than salary scales alone when deciding major professional translocation.
Adequate funding of healthcare is vital for this to be possible. Although healthcare funding has never been luxurious in New Zealand, we have had more than 30 years of neoliberal austerity measures which have seen our healthcare system fall ever further behind of what is required for adequate provision of care, let alone maintaining a fulfilling environment for healthcare professionals. Our rank order among OECD countries has declined significantly. The gap between haves and have-nots has widened, and this is accompanied by increasing demands on the health sector. Deprived populations bear the brunt of the shortcomings. Poor infrastructure maintenance and failure to meet growing population needs became increasingly apparent, and the Covid pandemic has exacerbated the problem. Staffing and facilities are now inadequately funded to meet current demands. The new health reforms/Te Whatu Ora are welcome if they redress the issue, but we wait with bated breath to read the fine print.
A call has been made for more staff, especially nurses and doctors. There is a world shortage at present, prompting keen international competition. For recruitment and retention of staff, conditions of service must improve. Some salary scale adjustments are indicated, but people are more likely to accept lower pay structures if there are good employment conditions. This is certainly not the situation in most New Zealand hospitals at the moment. GPs also face the unacceptable burden of caring for increasingly sick patients who cannot gain access to recognised necessary treatment.
Our health funding system for healthcare needs total revision. Many well-researched models provide valid comparisons, including those in France, Germany (social insurance) and Scandinavia (social democratic). Our population has to face reality and pay for a better system with better funded resources. Some in New Zealand have recently suggested that there should be more restrictions applied, aiming to relieve hospitals of the burden of elective patient problems. In effect, it would be "more of the same", only worse, with those who could pay treated in private, the remainder deprived of healthcare services. That abhorrent suggestion would take us closer to the American system, where they have the most expensive system in the world and poor measurable outcomes for the general populace, and where healthcare debt is the commonest reason for bankruptcy.
Commercial interests and healthcare are uneasy bedfellows, with potential conflicts of interest already being investigated in New Zealand. The spirit of the Treaty of Waitangi is important in this equation. It requires us to care for all our population; the indigenous people and many others have special needs which cannot be ignored. In contrast, a relatively poor country, Costa Rica, has elevated its health system from poor to good, superior to the United States, by applying different funding and social criteria.
There is no reason why we could not achieve a better, more equitable service in New Zealand. The proposed policy of simply reducing taxes for the wealthy to attract foreign doctors, as touted by some politicians at present, is not the answer. It requires strategically directed, better financial support for healthcare, education and housing, all interrelated factors vital for improving health status of a community.
Gil Barbezat is an emeritus professor of medicine at the University of Otago.
