Wages last thing on departing doctors' minds - study

A study of junior doctors leaving Canterbury District Health Board (CDHB) has found career development, training opportunities and travel were the main motivators, with wages a factor in just 5 per cent of cases.

The report is published in the New Zealand Medical Journal today, as more than 2000 junior doctors return to work after their second two-day strike in a month in support of a 30 per cent pay increase over the next three years.

The study, by CDHB and University of Otago staff, looked at exit questionnaires which had been filled out anonymously by departing junior doctors in the year to October 2006.

During that period nearly half the 425 junior doctors left.

"Most often the reasons for leaving related to factors outside of the organisation's control such as career development (31 per cent) or travel (24 per cent)," the report said.

Of the various reasons recorded, wages placed a distant last.

Despite heading to new jobs, most leavers said they had been highly satisfied with their workplace.

"Junior doctors live in a wider environment than the hospital system and have plans to travel, to pursue a career and experience life in other countries," Dr Craig Lynch, a surgeon who left the country to work in Australia, wrote in an editorial for the journal.

Among those with complaints, the most common issue was a lack of training opportunities.

"As a relief house officer the teaching is ad hoc. This is the nature of the job and would be difficult to change," one respondent wrote.

In support of their training complaints, the study showed junior doctor numbers had leapt from making up 12 per cent of the medical workforce in 1985 to 56 per cent in 2005.

In comparison the Clinical Training Agency, which provides financial support for training, does so for just half the number of doctors needed to fill the CDHB roster.

The study said the DHB's rapid patient turnover meant much of the doctors' time was being taken up with "secretarial" tasks.

It recommended the urgent removal of administrative tasks from medical staff through the creation of new roles such as clinical and non-clinical assistants.

This would allow doctors, and nurses, to maximise their clinical time, increasing efficiency and creating more time for training.

The study found the exodus was not the sole cause of staff shortages.

The large numbers of British and Irish-trained staff who were being imported to swell the ranks were staying, on average, just 11 months before heading home to continue their training.

New Zealand's hospitals remained reliant on overseas doctors as, regardless of the staff retention issues, not enough new doctors were being produced locally.

The number of doctors employed at CDHB in 1986 was 60. By 2007 there were 425 - a 600 per cent rise.

In roughly the same period, the limit on admissions to the two New Zealand medical schools was increased by 45 students (16 per cent).

A further increase of 40, to 365 a year from this year, would not produce graduates for about six years, and the increase would not be sufficient, the study said.

With the acceptance many doctors would head overseas for both personal and professional reasons, the study suggested DHBs organised overseas postings for doctors with the proviso that they returned for a specific period.

"The advantages to the individual and to the DHB would far exceed that of a poorly directed overseas experience," it said.

Dr Lynch said to encourage graduates to stay and to lure others back, changes would have to be made to make New Zealand an attractive option.

"The hostile environment generated by difficulties relating to patient care, protracted union negotiations and strikes is not conducive to recruiting and maintaining clinicians," he said.

"Graduates moving overseas for training are exposed to an environment offering long-term jobs with better financial rewards, research and education opportunities.

New Zealand must compete on all these levels...to attract these people back.

"Importantly, there needs to be a revision of the current expectation that New Zealand graduates will return to work on a `take it or leave it' basis, as clearly the latter option predominates."

Dr Lynch warned that if New Zealand did not become internationally competitive, it would also face difficulties recruiting overseas doctors who would take their skills elsewhere.

- NZPA