Dr Michael Bassett

Dr Michael Bassett

Newspaper Columns


Doctor numbers

20/01/2004
I'm always disappointed when I see gullible journalists lending themselves to publicity stunts by health pressure groups. The public has little understanding of health politics and can be inclined to take at face value misleading assertions by pressure groups. Journalists therefore have a special duty of care. They seldom exercise it.

In recent days both the Dominion Post and the New Zealand Herald have unquestioningly repeated assertions by medical organisations that are obviously intended to gain large amounts of additional taxpayer funds for general practitioners. Building on protests from Australian doctors who seem to feel that New Zealand's medical graduates are undercutting their efforts to squeeze more out of their government, Dr Tricia Briscoe of the Medical Association and Dr Deborah Powell of the Resident Doctors' Association have mounted a campaign for more doctor subsidies on this side of the Tasman. There might be something to some of their claims, but the supporting evidence is woefully inadequate.

Yes, it's clear that a lot of our young doctors are going to Australia on OE or the temporary lure of higher contract pay. This has been the case for fifty years or more. But is the exodus bigger than, say, in the 1970s and 1980s? And do we know whether they are staying away in larger numbers for longer periods? And are student loans the key reason for any increase in departures, assuming it is occurring? Is there really a doctor shortage here? On the evidence presented so far the Briscoe-Powell claims seem impressionistic, and little more than overblown rhetoric. We need facts. Otherwise we are entitled to believe they are doing no more than the usual softening-up process before negotiations begin with government over pay and conditions.

New Zealand has always trained doctors to a high international standard. Many Otago graduates, and later, Auckland graduates as well, have gone overseas either for the experience, for OE, or for further training. On one occasion Prime Minister Sir Joseph Ward counted 23 New Zealand medicos when visiting Edinburgh in the early twentieth century. Many Otago graduates set up practice in Britain. Names like Aucklander Dr Bernard Myers, who became a Harley Street physician, Sir Archibald McIndoe the famous plastic surgeon, and Sir Arthur Porritt, the Queen's surgeon, spring to mind. They weren't losses to New Zealand. With medical practitioners, as with other professionals, you can take the practitioner out of New Zealand but not New Zealand out of the practitioner. Myers became Director of Medical Services for the New Zealand troops in World War One; McIndoe trained a generation of New Zealand's plastic surgeons during World War Two; Porritt leapt at the opportunity to become our Governor-General in 1967. Medicine may well be the first discipline to have globalised, and we are the better for it.

Later generations of doctors also returned. It depends in large measure on the state of New Zealand's economy at the time. I was Minister of Health just after we hit the wall in 1984. Many young doctors fled to jobs overseas, not to avoid loan commitments (there weren't any in those days), but to improve their prospects. We had to recruit junior doctors from abroad. It wasn't difficult. South Africans came readily. After nearly ten years of good economic performance, doctors now feature amongst returnees to New Zealand, despite student loan commitments. Perceived family opportunities, plus an abiding love of the country, over-ride other considerations. Don't let us depress the economy once more with excessive tax-paid subsidies. That really would slow their return.

There has always been difficulty finding doctors for remote places. Long before my time, the Health Department designated "special areas" and subsidies to attract them to the East Cape, the Far North and the West Coast. But money isn't enough. Schooling for kids is often more influential. I suspect that twice the money invested in Annette King's "Step Up" scheme would draw few more missionaries to remote areas.

Which is what makes Dr Briscoe's solution of increasing GP subsidies "to ALL (my emphasis) parts of New Zealand" so silly. How could that possibly attract another doctor to Te Kaha or Haast? They'll just group where they do now. And what does she think the flow-on effect would be if one expensively-trained profession had its fees wiped or discounted? Please explain.

Pressure groups should be more thoughtful with their assertions. And the journalists who breathlessly mistake their words for gospel, should ask searching questions before printing them.