More and more junior doctors are being lost in the training pipeline before they emerge to bolster the stressed ranks of specialists, data suggests.
A new estimate from the senior doctors' union puts the loss rate at about 40 percent compared to just 16 percent a few years ago.
The analysis, passed by the Association of Salaried Medical Specialists to the Productivity Commission, was more bad news for the stressed health workforce.
"Many junior doctors are not entering specialist training," its submission said.
In part, it blamed a rise in overseas junior doctors doing a short stint here, like a medical OE, and the junior doctors' union said it was seeing this, too.
"They don't want to complete all the exams and all the training to become consultants," said Deborah Powell.
Powell, the Resident Doctors' Association's national secretary, also blamed an increasing drain to Australia of juniors at the advanced stage of training.
"They're being actively targeted by Australia."
Te Whatu Ora said "in the past" registrars had been sought, and come to New Zealand especially from the UK, to help cover winter and spring peak demand.
"We can't confirm ASMS's figure for loss of trainee doctors - we're not sure how they would have calculated it."
The Crown agency did not say whether it would find out.
It had five data working groups with 74 members, but had been unable to provide some basic data to the unions or to RNZ.
The ASMS did its own analysis by assuming an average length of house-officer and specialist training being eight years. It then compared how many entered training in 2014, with how many emerged in 2022. It did the same for 2006-2014.
It said the official data ran out in 2017, and when it sought an update, "Te Whatu Ora say they don't hold it."
Both unions said the flawed system must change to prioritise local medical college graduates more likely to stay.
"We are effectively giving priority to training places in our hospitals, to doctors that we know will not stay here," ASMS executive director Sarah Dalton said.
"It doesn't make much sense, but it seems to be the way we've been doing things."
Not all junior doctors from overseas took up training positions, Te Whatu Ora said.
But Powell said some did, even where they were not actually training.
"Every single [registrar] should be training to be a GP or a surgeon or a pediatrician or whatever," she said.
Instead, the system had favoured having all hands to the pump, even at the long-term expense of specialists.
"Those people only interested in service delivery think it's fine, the rest of us don't," Powell said.
Australian bias?
Te Whatu Ora said because training was mostly run by Australasian medical colleges, "some trainees locate back and forth as part of their training".
However, the colleges were being run to primarily suit Australia's needs, Auckland University emeritus professor of medicine Des Gorman, who led the government's Health Workforce NZ until 2019, said.
The training was shifted to line up seamlessly trans-Tasman-wise several years ago, a mistake the union was asking to have reversed, Powell said.
"District health boards, in one sense, helped the exit of our advanced trainees to Australia," she said.
Gorman said more local control of training was vital, as well as a more secure career path for registrars-in-training
But recommendations for this way back in 2009 from a taskforce he was on, had been ignored, he said.
The Resident Doctors' Association is trying to introduce a new service along those lines now.
Figures from the Medical Council show the number of overseas medical graduates had crept up to 41.2 percent of the workforce.
Of those from abroad who did go on to get vocationally registered here, the ASMS estimated 40-50 percent did not stay long term.
Attrition and ageing
Medical Council figures show the number of doctors in training rose by 8 percent in the two years up to June 2022, to a total of 3731 across all specialities, well ahead of population growth.
However, many specialities had reported rising stress in the face of ratcheting demand from shortages among the likes of anaesthetists and radiation oncologists.
The drop out and drain rate among trainees is made more alarming by an imbalance in the ageing workforce.
Read the document: 'Ratio of trainee medical specialists to specialists aged 55+ and aged 60+' Source: ASMS, based on data from Medical Council (PDF, 66KB)
"This shows it's very vulnerable to older people reducing their work hours or retiring," Gorman said.
Health Workforce NZ had used a similar, if more complex, "vulnerability measure" when Gorman headed it, he said, but the measure had been dropped.
Asked about this by RNZ, Te Whatu Ora said: "Te Whatu Ora does not use a 'vulnerability measure'.
"We do hold the data to check what ASMS is saying, but this will take time." It asked about turning this into an Official Information Act request instead, which would take weeks to answer.
When RNZ asked the agency for the numbers of trainee doctors in each year of a speciality, which would show how many per year could be expected to emerge as consultants, it did not provide them.
The trainee numbers Te Whatu Ora did give - just the totals per year - were borrowed from Medical Council surveys.
The government's own survey of trainee doctors was discontinued in 2018 and had not been reactivated.
"They do not have much of their own data," Gorman said.
"They absolutely should have."
Filling the data gaps was one of the top two priorities that the junior doctors' union had asked the national health workforce taskforce to address.
The senior doctors' union, the ASMS, told the Productivity Commission the government must do a health workforce census, forecast the demands, then do a gap analysis.
"We don't yet have a shared dataset" to debate "what is the need, what is the plan to grow", Dalton said.
Both unions last week expressed a crisis of confidence in the national health workforce taskforce. Gorman was scathing of it, too, and said it lacked members with the right experience.
While Australia looms large for health workforce planners here, New Zealand does not get a mention, except in citations, in the Australian Medical Workforce Strategy 2021-2031.
