ASMS Direct - Issue 2010-10
16 August 2010
Dear Member
We welcome any feedback on the contents of the 10th issue for 2010 of ASMS Direct, our national electronic publication. This copy of ASMS Direct focuses on:
1. Specialist workforce crisis in DHBs highlighted
2. The pain that is Paul Henry
3. CTU campaign revs up on government’s proposed industrial law changes: fairness at work
4. Brief update on national DHB MECA negotiations
1. Specialist workforce crisis in DHBs highlighted
Over the past week the specialist workforce crisis in district health boards has been highlighted in the public arena. On 8 August, TVNZ’s flagship Sunday current affairs hour long programme devoted two-thirds of the time to the subject, particularly focusing on the continuing drain to Australia. It included interviews with ASMS National Executive member, Dr John Bonning (emergency medicine, Waikato Hospital) and specialists who have gone to Australia. This was followed the next day with me being interviewed for around five minutes on TVNZ’s Breakfast programme.
Yesterday the Sunday Star Times, which reportedly has the highest newspaper circulation in New Zealand, ran a prominent article on an issues paper prepared by the ASMS on the specialist workforce crisis. The ASMS also released a media statement yesterday (available on our website) commenting on the issues paper. The statement and paper was picked up by the NZ Press Association (a central service for newspapers), and led to an article in the NZ Herald this morning as well as radio interviews for the Newstalk ZB network, Radio Live, and other private radio stations.
The issues paper is intended to better inform decision-makers (including government, Ministry of Health, and DHBs), the media and the public of the extent of the crisis and to encourage the taking of urgent action to help address it. A copy of the paper is attached. I strongly encourage you to download it and read it. It is also available on our website.
2. The pain that is Paul Henry
As discussed above, on 9 August I was interviewed on TVNZ’s morning Breakfast programme following on from the previous evening’s Sunday programme. The interview was conducted by co-host Pippa Wetzell who handled it in a professional manner. Immediately after the interview there was some discussion between her and fellow co-host Paul Henry. Immediately below is the transcript:
WETZELL: It is very difficult. Because the other side of it too, is if we don't have as many local doctors and we're bringing in immigrants to fill those gaps, then, obviously, there's more training required there, and the doctors who are here have a more challenging job.
HENRY: Well, these immigrants can't be as good as our doctors...
WETZELL: Well...
HENRY: …or they would...
WETZELL: …they haven't been trained in the same way.
HENRY: They would stay overseas wouldn't they? They would stay overseas...
WETZELL: Well…
HENRY: …if there's an opportunity to make more money overseas.
WETZELL: Lifestyle choice for them to be here though.
HENRY: Yeah, yeah. Very complicated.
In response to this ‘banter’ I emailed Breakfast later that day including the following observations:
Comments made by your co-presenter Paul Henry immediately after my interview this morning (Monday 9 August) concerning overseas trained doctors in New Zealand have caused some concern among senior doctors in public hospitals…
Mr Henry's comments that these overseas trained doctors can’t be as good as our doctors are unfair and incorrect. I appreciate that Ms Wetzell offered alternative views and that Mr Henry did acknowledge as the final comment that it is a complicated issue. Nevertheless it left an unfair impression in the viewers’ minds. Some clarification is required.
Overseas trained doctors do provide considerable benefit to New Zealand offering diversity of international experiences. The issue is not competence but rather increasing dependence. New Zealand has the highest rate of overseas trained doctors in the OECD at over 40%, and increasing at roughly 1% per annum, which is around double the second highest (Australia). We are not retaining enough of the doctors we train. It is not a reflection of the doctors we recruit internationally but the loss of doctors that we train. New Zealand is not competitive in an international medical labour market leaving us with too many shortages and the remaining medical workforce overstretched.
This situation is not cost effective because it is more economical to retain what we train rather than recruit internationally as much as we do. District Health Boards advise us that the cost of filling a vacancy by an overseas trained specialist in the first year is around three times the annual salary. Further, significant numbers of overseas trained hospital specialists leave New Zealand within two years.
Countries develop different training systems that meet their own needs. For example, in economically less developed nations the training is deliberately and wisely broader and more general than New Zealand. This does not make these doctors lesser than those we train but they are trained differently because of different health need priorities. Even among developed countries there are differences. For example, in surgery in some western European countries surgeons specialise sooner than in New Zealand (and Australian and the United Kingdom) and consequently are not always immediately able to do the relatively wider range of surgery that is expected in New Zealand. Another example is paediatrics in the United States where the training is much more general (an extension of GP training) in a primary care setting compared with the relatively more specialised training in a hospital setting. It is not that doctors recruited from overseas are lesser or better than those we train but some of the training systems are different and this can pose additional costs to the health system.
Having overseas trained doctors in New Zealand is positive for our health system but the balance and dependence is wrong including fiscally non-robust.
I would be grateful if you could inform your viewers of this background clarification tomorrow in order that a negative impression is not left over their competence and calibre.
The ASMS has not received a response to this email and, to the best of our knowledge it was not discussed subsequently on Breakfast.
3. CTU campaign revs up on government’s proposed industrial law changes: fairness at work
The government is proposing significant changes to the Employment Relations Act which provides the main legislative basis of industrial law in New Zealand. The ASMS National Executive has yet to have the opportunity to assess the implications of these changes although they do raise concerns.
The Council of Trade Unions has responded with a campaign which it calls ‘Fairness at Work’. The CTU believes these changes constitute a government attack on the employment rights of all wage and salary earners. It is a campaign for three main issues:
· All employees to have protection against unfair dismissal.
· The preservation of employees’ right to free access to union officials in the workplace.
· No change to the rules on a doctor’s certificate for less than three days sick leave.
· Its assessment is that all employees (including professionals) will suffer (or risk suffering) a reduction in the quality of their working lives if these and other measures are passed. The next stage of the CTU’s campaign is for national rallies on 21 August (or 22 August in Dunedin). The CTU has a website www.fairness.org.nz and a Facebook page at: http://www.facebook.com/pages/Fairness-at-Work/113487335368284.
The rallies scheduled are:
Auckland - 1pm, Saturday 21st August, QE2 Square (bottom of Queen St, opposite Britomart)
Wellington - 1pm, Saturday 21st August, Civic Square
Christchurch - 1pm, Saturday 21st August, Cathedral Square
Dunedin - 11am, Sunday 22nd August, assemble at Dental School, Great King Street, march to rally at the Octagon.
A ‘national day of action’ is also scheduled for 20 October.
4. Brief update on national DHB MECA negotiations
Negotiations continue to progress in a constructive manner with the DHBs. We have completed our four workshops which provided the basis for some positive in-depth discussion on the important issues of (a) the status of the senior medical workforce in DHBs; (b) trends in Australia including the current specialist labour market; (c) achieving comprehensive clinical leadership at all levels of DHBs including at the departmental or service level; and (d) the implications of the Resident Medical Officers Commission recommendation that were adopted by government for senior medical and dental officers working in DHBs.
We have also had three days of formal negotiations (the last being on 2 August) as well as other important informal discussions. The ASMS has not yet tabled any formal claims on the main financial issues (salaries, superannuation, after-hours’ remuneration, and CME expenses) and it may be possible that we can resolve them without formally tabling claims. We have a fourth day of formal negotiations on 8 September.
Kind regards
Ian Powell
EXECUTIVE DIRECTOR
