ASMS Direct - Issue 2011-27

30 November 2011

Dear Member

We welcome any feedback on the contents of the 27^th issue for 2011 of ASMS Direct, our national electronic publication. This issue covers the following matters:

• 1. Reminder: Membership ballot on provisional agreement for the next National DHB MECA
• 2. More on the ‘800 extra hospital doctors’ controversy
• 3. Nominations called for Medical Council
• 4. Medical Council Consultation: Proposed framework for the regulation of “special interests”

1. Reminder: Membership ballot on provisional agreement for the next National DHB MECA

By now members should have received their ballots along with accompanying background information and a letter from National President, Jeff Brown. Information about the proposal can also be accessed by going to the ASMS homepage www.asms.org.nz and clicking on the highlighted section on the upper right hand side.

We are recommending a ‘yes’ vote but have also been explicit about the weaknesses of the proposal. The most important thing, however, is not whether you support or reject the recommendation but whether you vote. A high turnout is more important than how you vote.

The closing date for returned ballots is Thursday 15 December (5pm). The Returning Officer is Executive Officer, Yvonne Desmond. If by any chance you have not received your ballot paper (and if you are employed by a DHB) please contact the national office immediately at asms@asms.org.nz.

2. More on the ‘800 extra hospital doctors’ controversy

In the previous ASMS Direct we reported the strong criticisms by delegates at the ASMS Annual Conference of the Minister of Health when he asserted that we no longer had a specialist workforce crisis in DHBs (as late as October 2010 he said it was still a crisis and his top priority) because there were now over 800 extra public hospital doctors since he became Minister of Health in late 2008. Despite incredulity from Conference delegates he continued to assert this maintaining that it was based on National Health Board data (the NHB is part of the Ministry of Health).

Last week we had the opportunity to test this when the NHB, on our initiative, attended our National Joint Consultation Committee with the DHBs to explain the robustness of this data. What became clear was that while whether the data was robust or not is a matter of debate, there was no doubt that the use of the data was not robust.

The biggest question is whether the alleged 800 extra hospital doctors include resident medical officers. However, the National Health Board could not break this down between specialists, medical officers and resident medical officers. This is basic but without this breakdown you can’t make conclusions about the state of the specialist workforce in DHBs.

As previously advised the best information available is a headcount (ie, actual bodies rather than ftes) provided by the DHBs directly to the ASMS. This data covering a similar period of time (1 July 2009 until 1 July 2011) shows the number on the MECA specialist scale increased by 228 (medical officers increased by 43). If the 800 extra hospital doctors is robust, then the government would have to be able to prove that the number of RMOs would have increased by over 500. While RMO numbers have no doubt increased it is hardly likely it is by this amount. If they have, the supervision and teaching workload would have to have increased considerably.

It also appears that the numbers are inflated because of the way ftes are counted. The NHB now calculates senior medical officer full-time equivalents (fte) on the basis of what it names ‘employed ftes’ in a way that inflates numbers. In summary, fte is seen as a 40-hour week. Someone who works less than 40 hours for their DHB is pro rated under this approach (eg, someone who works 30 hours for the DHB is counted at 0.75. Someone who works more than 40 hours per week is, however, counted as 1.0 (eg, someone who works 50 hours for the DHB is counted as 1.0). This may be more robust than previous forms of calculating medical ftes but it is not a headcount. If job sizing reviews lead to an increase in paid hours to part-timers (eg, from 30 hours to 40 hours per week), the total fte increases but not the headcount; it is the same senior doctor. There has been a lot of job sizing over the past two to three years, including in the more populous three Auckland DHBs. Part of this is the greater recognition of time for non-clinical duties.

In summary the session with the National Health Board gave the ASMS no confidence about the utilisation of the medical workforce data it has reported to the Minister of Health.

3. Nominations called for Medical Council

The Medical Council has called for nominations for appointment to the Medical Council. During March 2012 the medical profession will vote to choose four medical practitioners to the Medical Council.

The names of the four highest polling candidates will be forwarded by the Chair of the Council to the Minister of Health with a recommendation that they be appointed as members of the Council for a three-year term from June 2012.

As a result of strong advocacy from the medical profession, including the NZ Medical Association and ASMS, the Minister of Health introduced regulations in 2009 stipulating that four members of the Medical Council would be appointed after election by the profession. It is important to show by voting and participating in this election, that the profession take this move by the Minister seriously and respect the acknowledgement of the importance of professionalism.

Nominations must be received by the Council by noon on Friday, 20 January 2012, with voting papers being dispatched on Friday, 24 February. Voting papers must be received at the Council on Friday, 23 March 2012 (noon). The nomination form, election process details and counting rules are posted on the Council’s website.

4. Medical Council Consultation: Proposed framework for the regulation of “special interests”

The Medical Council is seeking your feedback on how “special interests” within a “vocational scope of practice” should be regulated.

“Vocational scopes of practice” provide a framework within which the Council is able to ensure that doctors are competent within a specialised field of medicine. However, some of these specialised fields can themselves be broad and diverse. Within a single vocational scope there may be several different areas of practice in which doctors should reasonably be expected to hold additional expertise above and beyond that they needed to obtain vocational registration. These sub-specialty areas are often referred to as “special interests”.

In the past the Council has taken a case-by-case approach in the way it has regulated special interests because different special interests present different levels of risk, and because the Council wishes to apply a level of regulation that is at the right touch for that particular circumstance (ie, a level that protects public health and safety, but does not place an unnecessary burden on doctors and health services). However, it appears likely that special interests will become increasingly prevalent and it is important that regulation in this area is clear, consistent and transparent. Consequently the Medical Council is proposing to introduce a framework to guide future decisions and policy development.

The Council advises that the framework mostly codifies what is already working well and for the vast majority of doctors it will have minimal impact on their practice or on their continuing medical education. The Council’s framework is intended to encourage doctors to improve their skills, and is not intended to impede innovation or to create barriers that prevent competent practitioners from working in their chosen field.

The Council has drafted a short consultation paper and seeks your feedback on this proposed framework. The closing date for comment is Monday, 16 January 2012. Your comments can be sent to mthorn@mcnz.org.nz.

Kind regards

Ian Powell
EXECUTIVE DIRECTOR