Health NZ has embarked on a series of job cuts. Photo: RNZ
More medical specialists are leaving the public health system - or reducing their hours - to work in private hospitals, according to Medical Council data.
A report just released by the senior doctors' union, A Spreading Problem, tracks the distribution of medical specialists between public and private work using that data for the period June 2022 to June 2024.
It shows:
- Net growth in the private sector (225.1 FTEs) was greater than in the public system (194.7 FTEs).
- Public hospital doctors are working harder: specialist public workforce increased by 4 percent - less than population growth adjusted for ageing (about 5 percent) and much less than patient numbers (11.4 percent)
- In the same period the private/other medical specialist workforce grew by 9.6 percent
- Ten specialities had net loss of doctors employed in the public system, including psychiatry and anaesthesia
- Five more failed to keep pace with population growth
- New Zealand currently short approximately 1800 full-time doctors
Senior doctors walked off the job last week for an unprecedented 24-hour strike after eight months of deadlocked contract negotiations for the Association of Salaried Medical Specialists.
Health NZ has applied to the Employment Relations Authority to do facilitated bargaining to resolve the dispute.
The union said the "lowball" pay offer (which is capped at 1.5 percent of total remuneration), will mean the public system is unable to recruit new doctors, or stop the ones it already has from going overseas or to the private system.
The new report, which updates data published in ASMS' earlier report, Creeping Privatisation, notes Health NZ's own Health Workforce Plan 2023/24 acknowledged "FTE flight to the private sector in some areas …can limit public capacity".
The total medical workforce employed across the public, private and other sectors grew by 5.7 percent in the two years to June 2024, but growth was not evenly distributed.
While the specialist workforce was current divided approximately 70 percent public/ 30 percent private, the balance was shifting.
For small specialities, the loss of even a couple of senior doctors made a huge difference, according to the ASMS report.
"For example, paediatric surgery lost 1.7 FTEs between June 2022 and June 2024, but that represents a 9.1 percent reduction.
"Similarly, the loss of 3.1 FTEs in cardiothoracic surgery amounts to a 12.6 percent loss of cardiothoracic surgeons working in public hospitals."
Even specialities that saw gains in workforce numbers - that is 21 out of 36 areas of medicine - were often coming from "a relatively low numerical base".
"For example, dermatology and rehabilitation medicine are not available publicly in many parts of the country.
"While the increases in emergency medicine are relatively large, that workforce would need an additional 105 specialists to be proportionate with the Australian emergency medicine specialist workforce on a per capita basis in 2023."
The number of patients showing up at Emergency Departments grew 15.5 percent in June 2024 compared with the same period two years previously, while "complexity" (how ill those patients were) grew by 16.7 percent.
"At the same time, recent media reports show all hospital emergency departments failing to assess patients with imminently or potentially life threatening conditions within clinically acceptable timeframes."
Intensive care medicine would have needed an additional 57 specialists to be proportionate with Australia; obstetrics and gynaecology would have needed 31 specialists.
Public-private/other movementIn a written response, Health NZ acknowledged having a "sustainable" specialist doctor workforce was key to improving health outcomes.
Health NZ national chief medical officer Helen Stokes-Lampard said the specialist workforce was "highly qualified", and there had "always been movement" between private and public centres, for personal and professional reasons.
"It is important to note that the report in question shows that the public hospital specialist workforces in 21 out of 36 specialities, actually increased above estimated population growth," she said.
"While we know there is more work to do, these results do show we are gradually moving in the right direction."
Health NZ was committed to retaining, developing and growing the specialist doctor workforce, including by recruiting from overseas "where safe and appropriate".
However, developing a sustainable health workforce required more than "just adding more people", they needed to work differently, she said.
"We need to change how we deliver care, shifting to new models of care and service delivery approaches, shaped by clinical leaders with patients at the centre."
Fifteen of 36 specialities saw a shift in doctors from public to private.
"Collectively those 15 specialities saw an net loss of 25.6 FTEs in public hospitals, while the private/other sectors saw a net gain 177.9 FTEs."
Just over 31 percent of the total hours worked by medical specialists was spent in "Private/Other" services in 2024: mostly in private hospitals or clinical practice, but also universities and government departments.
For surgical specialities, more than a third (35.3 percent) of worked hours were spent in the private sector, and a further 3.5 percent were spent in other employment.
In dermatology, oral and maxillofacial surgery, palliative medicine and ophthalmology, there were more doctors working in private than in the the public system.
Orthopaedic surgeons and radiologists were split 50-50 between the two.
"The division of the specialist workforce across the public-private/other sectors would not necessarily be an issue if there was sufficient specialist workforce capacity to meet health need in the public system," the report said.
"The effects of the workforce split have to be seen in the context of workforce shortages in each speciality, where every specialist moving to the private sector can exacerbate the shortage in the public sector."
The shift towards private health services created "a double disadvantage for those who can't afford health insurance or to self-fund their care" - mostly Māori, Pacific Peoples and lower-income groups - who were already missing out on primary care due to cost.
Health Minister Simeon Brown said under the current Government, the front-line workforce was "stronger than ever before".
"Since 2023, there are more than 1700 additional nurses and more than 200 additional doctors working in our public health system," he said in a written statement.
"Health NZ's latest offer to the ASMS union sought to address a number of the key issues raised by the union to attract and retain Senior Doctors, including offering bonding of $25,000 for Senior Doctors who move to hard to staff regions for two years.
"Instead of putting this offer to members to vote on it, the ASMS union rejected it, and went ahead with pre-planned strike action that affected thousands of patients."
Brown said he continued to "urge the union to get back to the negotiating table".
The ASMS has said it continued to negotiate with Health NZ, but the current offer had not changed substantially on that previously rejected by its members.
It maintains that while the most recent offer included more money for first-year specialists (to ensure they were not paid less than junior doctors), it only amounted to a 1.5 percent pay-rise over two years for most of its 5500 members, who were already at the top of the payscale.
