British NHS doctors, managers, escape to New Zealand - but high turnover continues
Doctors move to New Zealand in droves to escape the British health service, but many fail to settle and the cost of turnover isn't clear.
In a study of medical migration, professors from the University of Otago investigated the movement of international medical graduates to the Southern Hemisphere.
New Zealand has one of the highest proportions within OECD countries of international medical graduates in its workforce.
Around half of the 3500-strong international work force hail from the United Kingdom but most do not stay longer than 12 months after registration, imposing significant costs on the New Zealand healthcare system.
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Unfortunately, those costs are difficult to measure but they probably run into tens of millions of dollars.
Medical migrants are motivated by the quality of life in New Zealand and increasing pressure on the state-funded service in the United Kingdom, where doctors, especially newly qualified ones, face increasing pressure working for the National Health Service (NHS).
A report in The Lancet earlier this year said the NHS was "creaking at the seams" and cited a British Medical Association survey of 1000 doctors, with three-quarters of that group saying they were unable to manage workloads.
Association of Salaried Medical Specialists executive director Ian Powell said there was no hard data available on the cost of hosting doctors trained overseas.
However, more managers who previously worked in the NHS were heading to New Zealand.
Powell said it was likely the "churn" of international medical graduates was a significant cost but no such data was available. It was clear, however, that there was a twofold aspect, the retention of overseas doctors and the shortage in domestically trained hospital specialists.
"[International medical graduates are] probably not a huge cost. The real problem is the churn.
"Doctors trained in New Zealand are very attractive to Australia because the training systems are the same.
"The difficulty [with the overseas trained professionals in New Zealand] is that many of them do not stay long. The real cost is the turnover although by the time they are here for about 10 years they do stay.
"There's an under-supply of positions. There's an over-stretched work force. We describe the system as having entrenched shortages, which have become the norm, at least in public hospitals."
In a snapshot of the public health workforce last year the association had this to say:
"New Zealand's high and increasing dependency on international specialists, and their high departure rate relative to New Zealand-trained doctors, raises the prospect of countries of origin gaining greater significance with regard to New Zealand's workforce losses."
Professor Robin Gauld and Dr Simon Horsburgh's study investigated the motives of UK-trained doctors, their experience in New Zealand and reasons for leaving.
Medical professionals leaving New Zealand shores has been a longstanding part of the medical sector.
Gauld said plenty of doctors from the UK stayed long term and almost one quarter of the medical profession in New Zealand was trained overseas.
"We have the highest proportion in the OECD of international medical graduates and within that doctors from the UK, it's about half of the international graduates.
"Five hundred or so a year are coming in to New Zealand or applying for registration.
"The big issue is without those doctors the health system would fall over. The ratio of patients to doctors would not be sustainable. It's the whole issue of whether we are training enough doctors in New Zealand."
In the United Kingdom, the NHS was under severe stress for the past three years, doctors dealt with extraordinary workloads, short appointment times, long hours and psychological pressure, he said.
New Zealand's healthcare system was widely seen as an environment with a better lifestyle.
"There are certainly things about practice here that were much less stressful. But we are a long way from the UK and inevitably it's the pull of family, children and aging parents [that leads people to leave].
"That's the big issue I think."
Medical professions trained overseas were beneficial for any healthcare system, he said.
"It's useful for doctors to work in different countries, they get exposure to work in different areas."
Director of clinical training at the Auckland District Health Board Dr Stephen Child said graduates of New Zealand universities routinely left for overseas, around one in five for any discipline including medicine.
There was too much reliance on overseas-trained medical professionals in New Zealand, although on the other hand there was a real benefit from having people with expertise learned overseas.
Perhaps 25 per cent of the work force would be a better target than the 40 per cent of the current workforce, he said.
"As a small island a lot of people go overseas.
"We've got two types of doctors coming here. Doctors from developing countries who come here to live and sit a licensing examination and a high percentage move on once they pass.
"Then we have doctors who come from developed countries.
"Anecdotally, we have done quite well out of the turmoil in the UK."
Previous studies highlighted how New Zealand's healthcare system would fail without doctors trained overseas but, equally, recruiting NHS professionals was not a sustainable workforce solution as 12 months post-registration almost half of newly registered staff have left, the study found.