Bullying Rife in NZ Hospitals

The NZDoctor.co.nz website reported today on last night’s Wellington medical forum on the subject of burnout in the medical profession.

Experts said that doctors in New Zealand aren’t good at giving each other the support and affirmation needed to avoid burnout. Furthermore, hospitals are rife with bullying

Hospitals rife with bullying
“A bullying culture exists at hospitals, said forum chair John Carter, clinical leader of haematology at the Wellington Blood and Cancer Centre…
Attendees at the forum, part of the Inaugural International Cancer Symposium organised by Otago University, Wellington, heard psychiatrist and academic John Adams emphasise the medical profession’s poor record of giving mutual support and feedback.
This is an important factor in burnout, says Dr Adams, chair of the Medical Council.
By the time doctors come to the council’s attention, when their behaviour is affecting other staff and patient care, stress and burnout have led to physical health problems.
Depressive symptoms, anxiety, sleep disorders and/or substance abuse will have developed, and a stigma is attached to seeking help, Dr Adams says.
The earlier the problem is identified, the more likely its impact on the individual will be ameliorated…”  read the full report here

Which is ironic considering that New Zealand’s laid back lifestyle is used as a major selling point to attract overseas doctors into the country.

New Zealand has been suffering a severe shortage of medical specialists for some time.

Coincidentally The NZ Herald published an article today headed Doctor shortage reaches ‘crisis’ level, saying that a spiraling shortage of doctors “has sparked a warning of future “severe safety issues” in New Zealand hospitals.”

Association of Salaried Medical Specialists director Ian Powell told the paper that the flow of New Zealand doctors overseas and difficulty of replacing them had put many hospitals in crisis.

Patients could suffer from increasing medical mistakes and treatment delays without urgent action, he said.
“The situation is already unsustainable. We’ll have severe safety issues if this continues.
“New Zealand is losing too many of the younger doctors we train so well overseas, losing too many of our current public hospital senior doctors overseas and struggling to recruit in a very tight and internationally competitive market.
“Eventually these chinks are going to get so big that the system breaks down.” … read the full report here

Some things you may like to know about the health service in New Zealand:


Understaffing

• There is a workforce crisis in New Zealand’s hospitals. Specialist senior doctors are being lost and there is a shortage of cancer specialists. Staff are lost to Australia (where the salaries are 35% higher) and to private practice. The causes are low pay by international standards, overwork and lack of resources to do the job.

• New Zealand has an estimated shortage of around 600 specialists and that’s set to get worse, according to the Association of Salaried Medical Specialists. Growth has not kept pace with increasing need in an aging population.

• The senior doctor’s union estimates there is a shortage of 638 medical and surgical specialists and that having to treat too many patients is driving doctors away from NZ. The country “needs at least 1100 more specialists if it were to match the number per head of population in Australia, the union says in a discussion paper based on data from 2007 and 2008.” Source NZ Herald.

• New Zealand’s has a high dependence on overseas-trained doctors, the highest in the OECD , who comprise 40% of specialists. In some areas, such as psychiatry, the figure is closer to 60%.

• So many NZ trained registrars go overseas when they’re qualified that it’s hardly worth training them at all. Medical registrars can earn around $70,000 more in Australia and  difference in salaries is one of the major drivers for the exodus. “The situation is a crisis and a crisis generally comes before a collapse” -says Association of Salaried Medical Specialists executive director Ian Powell.  See the bullet point above for the other drivers.

But its not just the medical profession that are suffering in New Zealand, patients are doing it hard too:

Adverse Effects on Patient Health

• A shortage of Oncologists in the central part of the North Island means that some cancer patients are being refused chemotherapy. Instead of being placed back on waiting lists patients are being referred back to their own doctors (as of Jan 2011) Affected patients include those suffering relapses of some cancers, including cervical, oesophagus and melanoma.

• The Chief Exec of the NZ Cancer Society said

“It might not be what we want to hear, but it is honest … It is good to know they will not be hiding patients on waiting lists.”

But the list of cancers that won’t be treated had only been intended for clinicians to see, not the general public.

• Cancer treatment services are under such pressure that current treatment levels are unsustainable unless more money is spent. Rationing is likely to “become a feature.”

• An economist said that New Zealand’s cancer-treatment rates were lower than the average for developed countries.”Already we have unmet need, so I guess the message is, get used to it.”

• 261 people in Canterbury are waiting more than six months for cancer-detecting colonoscopies, raising alarm among doctors. In July 2009 the figure stood at 75 people. A private procedure costs £1,000.

• A “postcode lottery” health system is failing people as there is “inequitable” access to treatment depending on where patients live. One woman failed to have a brain tumour diagnosed for over three years. A report into her case has highlighted serious deficiencies within NZ’s public health service.

• Hospital errors causing serious harm are rising. In the year to June 2010 there were

“374 patients who were involved in a serious or sentinel event, of whom 127 died; compared with 308 events, including 92 deaths, the year before.”

Migrants Tales

Are you still considering a move to NZ to work in the medical profession? Read some of our Migrants Tales, for example this one
“The Health Care System Is Second Rate”

This story was written by a nurse with over 30 years of experience. In it she tells of prejudice and how difficult it was to find a job. She also talks about how thousands and thousands of health care dollars are being wasted because there is no incentive to change and of how people wait so long for some tests and treatments that permanent damage is done to their health. She is minded to stay and work through this but her Kiwi partner is starting to look toward Australia to make some money….read on

You may also find interesting:  “Kiwis Missing Out On Vital Medicines with Fatal Consequences”


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New Zealand Health Service Plummets in Ratings

New Zealand has moved from first to fifth place in international health rankings of seven countries, carried out by the Commonwealth Fund (click table above to enlarge)

The slide is  due mostly to issues of access, high costs preventing people from visiting doctors or filling prescriptions, safety and management of chronic illness and New Zealanders being the patients most likely to get an infection whilst in hospital. They were also in the bottom three for medication errors and being the victim of a medical mistake.

Interestingly, it was ranked last for the percentage of money spent on health administration and insurance. According to Stuff:

Labour health spokeswoman Ruth Dyson said the fall was “devastating”.
New Zealanders had worked hard to get an excellent healthcare system and were now “just watching [it] slip away”.
Government contracts held by district health boards for community-based management of chronic conditions had been cut around the country, she said.
The high infection rates were a surprise, but could be the flow-on effect of Government “penny pinching”.
It was disappointing New Zealanders were still struggling to access primary healthcare as it was crucial to early treatment and keeping people out of hospital, she said…”

Per head Australians spent US$3,357 on helathcare, Canadians US$3,895, Germans US$3,588, the Netherlands US$3,837 and Britons spent US$2,992 on health in 2007. New Zealand spent the least at US$2,454.

We can’t say that we are surprised by New Zealand’s poor showing and this is why:

New Zealand has a workforce crisis in its hospitals with specialist senior doctors being lost, there is also a shortage of cancer specialists, paediatric surgeons  and radiologists and when doctors and specialists speak out about their concerns over patient safety they are censured, most of them simply resign rather than take the flack for being a whistle blower.

The average medical student in New Zealand finishes training with a debt of $75,000, forcing many of them overseas soon after graduating. Australia is their most likely destination. But money isn’t the only factor making them leave. One study found that  just 25% of students believed they would be valued as employees by hospital management or the Government, something that affects their long term commitment to their country and has implications for specialist training.

261 people in Canterbury are waiting more than six months for cancer-detecting colonoscopies, raising alarm among doctors. In July 2009 the figure stood at 75 people. A private procedure costs £1,000.

The Health Ministry is allegedly among the worst performing government departments. According to a report card ranking state agencies and bosses excessive red tape, bureaucratic systems and ineffective consultation hampering  a number of government departments. It placed the Health Ministry bottom for value for money overall, and said it was “struggling“ and

“really confused, with too many sections not knowing what others are doing, and doing stuff without consultation in the affected communities.”

Disgust at the plight of one hospital -Hawera – has inspired a well-placed business analyst to blow the whistle on what he sees as millions of dollars worth of financial inefficiencies and loss at the deficit-plagued Taranaki District Health Board.

Paul Anwyll left his job as a business analyst at the TDHB’s Management of Information Unit…citing “weak leadership and poor management” as reasons in his letter of resignation. An experienced auditor, the Englishman said he had identified financial problems and loss but the TDHB had refused to consider his proposal of a test study that could potentially save them millions.”

Pharmac doesn’t allow New Zealanders to access new medicines for five to 10 years after they are widely used elsewhere in the world. It  waits until they are generic until they are widely used. The system keeps prices down for the Government but is criticised for restricting drug choices and delaying the arrival of some new medicines.

There was a 50% rise in complaints against pharmacists in the year to June 2009 , including 5 pharmacists who were convicted of crimes. Similar sounding and look-alike medications are ‘to blame’ for the rise. City Health Pharmacy in Palmerston North was fined $10,000 in 2008 after six drug dispensing mistakes in two years, including giving a two-year-old an anti-psychotic drug instead of cough medicine; it’s still in business. There is no compulsory bar-coding of drugs.

For a first hand account of what it’s like to work in New Zealand’s health service you may wish to read our Migrant Tale  “The Health Care System is Second Rate.” Written by a nurse with over 30 years experience, she talks about resistance to change and the wastage of thousands of dollars because there is no incentive to change things.

At the time nurses in Nelson were speaking out about horrific workloads that were causing many to resign. Nurses went public because of a lack of action when they raised their concerns with the New Zealand Nurses Organisation and hospital managers.

For more read our Health and Death page on Wordpress.

One reader of the blog left the following comment for us a week ago, if health care in New Zealand matters to you you may wish to read Gareth Morgan’s book -see a report on it here

I would like to mention that gareth morgan has a book about the nz health care system that anyone migrating for the health care ought to read, seriously.
Health Cheque: The Truth about NZ’s Health System it is called
It’s a frank book that discusses the problems with the way they rationalise care in which he states a theory that the high quality of the doctors and nurses are the only thing holding the system together.
Yet New Zealand has the highest percent of migrant doctors in the OECD, a staggering 52%
http://hpm.org/en/Surveys/The_University_of_Auckland_-_New_Zealand/15/Strategies_to_overcome_workforce_shortages.html
says in the review this book that:
“The New Zealand health workforce is under pressure from a number of sources. In addition to those problems that are shared by other countries – such as an increase in the proportion of part-time workers due to the feminisation of the workforce, increased demand for health services, and the aging of the health workforce – New Zealand faces major challenges from the internationalisation of health workers. It has the highest percentage of migrant doctors among OECD countries (52 percent compared with an OECD average of 36 percent) and one of the highest for nurses (OECD, 2008). **It also has one of the highest rates of outward migration of health workers. Four years after graduating, around 25 percent of NZ trained doctors are no longer registered in New Zealand and the loss increases to around one third after 9 years.**”
The doctors and nurses seem to mostly be british people who are outdoorsy migrants, or locum americans taking a working vacation, or political or crime refugess who could not get into other countries such as oz or canada. The kiwis just bugger off out of their own country and people from countries where the native language is not English are often only offered less responsible positions, in caregiving and cleaning.

The National led government has recently announced that it will be putting further pressure on the health service by giving employers the authority to make workers obtain GP sickness certificates for a single day’s sick leave from work.

“General Practice New Zealand chairwoman Bev O’Keefe said the change could put pressure on medical centres.
“The issue for general practice is how we accommodate all those people who need to claim medical certificates because they will need to be seen and assessed which means they are going to impact on what is already the heavy workload of general practice. “One thing we are not happy to do is to furnish medical certificates without seeing people because that’s just hearsay.” Another issue was people may go to work ill.”

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