New Zealand’s doctor shortage is well established, and both major parties are promising to train more should they be elected. Each year, however, a number of fully qualified New Zealand medical school graduates don’t get hired. What gives?
Alarm bells have been ringing across the health system. Like many countries, and exacerbated by the pandemic, Aotearoa is in the midst of what some have described as a health workforce crisis. Along with nurses, midwives, pharmacists and dental practitioners, New Zealand needs more doctors.
Despite this shortage, some say a valuable source of doctors remains overlooked. That is: many medical students who graduate at local medical schools are not offered jobs as junior doctors.
In fact, in 2022, 22 fully qualified graduates from New Zealand medical schools were not offered first-round employment in these junior doctor – or, as they’re known within the profession, house surgeon – roles. In 2021, the situation was much the same, with 23 graduates missing out on employment. “We’re talking about how we need more doctors,” said New Zealand Medical Students Association vice president advocacy Indira Fernando. “Well, here they are.”
In Fernando’s view, this hiring gap is a multifaceted issue that affects a diverse range of aspiring doctors – but some more than others. Central to the problem, she says, is that for several years the number of junior doctor positions available has been lower than the total number of medical students graduating in Aotearoa. And the vast majority of these young doctors missing out on employment are international students who have trained here.
Medical student Oscar* has spent the last six years studying medicine in New Zealand. He’s in his final year of study, and last week sent his application to ACE, a centralised system that matches student graduates to junior doctor jobs. Unlike traditional job applications where you reach out to employers with a CV, medical school graduates send their information to ACE and are linked up with placements based on factors like where they want to work and where they rank on a point system.
In late August or early September, Oscar will find out whether he’s secured a role for the first quarter, which begins in January. But because he’s an international student his chances aren’t particularly high.
This is because, within the ACE scheme, applicants are sorted into categories of preference. Category one, the top preference, is for New Zealand/Australian citizens who graduated from a New Zealand medical school, followed by category two or New Zealand/Australian citizens who graduated from an Australian medical school, with the lowest preference being category three or non-resident/non-citizens (international students) who graduated from a New Zealand medical school. Within this system, all of category one must be offered employment before category two, then all of category two before category three. By the time jobs have been offered to the first two groups, there’s barely a crumb left for international students.
In 2021, the ACE scheme received 561 applications; of these, 523 out of 524 from category one were matched, as were five out of 15 from category two. Not one of the 22 international student doctors who applied were matched with a job. In 2022, once again, zero international students were matched.
Oscar supports the prioritisation of New Zealand citizen students who have studied in New Zealand, but is perplexed by the prioritisation of Australian-trained students over international students who have studied in New Zealand and attained knowledge specific to local communities.
Daniel Pallister-Coward, Te Whatu Ora regional director of hospital and specialist services, acknowledged that within the current settings, some medical students could wait some time to be placed, but said the limited amount of first-round spaces was linked to limitations on the necessary clinical supervision and training for junior doctors in these roles. “During their placements, graduate doctors are supervised by senior doctors to ensure the safety of them and their patients,” said Pallister-Coward. “It’s important that our graduate doctors are well-supported to set them up for success, so there are a limited number of placements available at any one time.”
In terms of the circumstances for international students, much of this comes down to the fact that “Te Whatu Ora does not control the number of international medical students who are accepted for study by universities,” said Pallister-Coward. It means that the number of available roles, which are based on training capacity, won’t always be a perfect match for the total number of graduating medical students.
If Oscar doesn’t get a first-round job, he’ll be put into a talent pool filled with others also hoping for a role. As positions open up, employers can dip into the talent pool and reach out to applicants – but there’s no guaranteed time frame or assurance there will be a job at all. For someone stuck in a kind of limbo between job insecurity and a visa that expires in March, “there is an anxiety to it all”, Oscar said.
Similar situations to Oscar’s are common across the international student cohort, said Fernando. “These are students who graduated from New Zealand universities who want to serve New Zealand communities, who are now being asked, despite the fact that we don’t have enough doctors, despite the fact that our system is struggling, please just sit there and wait for a job,” she said. “Why are we playing hard to get when we very obviously need doctors?”
Last week, a health workforce plan developed by Te Whatu Ora and Te Aka Whai Ora with the clinical workforce, professional bodies and unions estimated a need for 1,700 more doctors (including GPs), with another 3,400 by 2032. In May, the NZ Resident Doctors’ Association estimated that New Zealand urgently needed an extra 300 medical graduates a year to keep up with a growing, ageing population and to replace retiring doctors.
As part of a range of initiatives designed to reduce pressures on the health workforce, in June, minister of health Ayesha Verrall announced the government would fund 50 additional places for enrolments at the country’s two medical schools, Auckland and Otago – increasing the cap from the current 538 to 589 places annually.
“We want to train and retain as many local health workers as possible,” Verrall said in the statement accompanying the announcement. “We have always been reliant on overseas-trained doctors, and we recognise the skills and knowledge the international workforce brings to our workforce. However, to address inequities in the system and build a sustainable workforce, we must grow and invest in our domestic doctors, especially when there is global competition for internationally trained doctors.”
The plan was met with mixed feelings by Fernando, who praised the additional funded medical school placements but was concerned that an additional 50 students might just add to the current “bottleneck” when it comes to finding junior doctor jobs at the end of the degree.
Te Whatu Ora’s Pallister-Coward said resources, including an “appropriate number of trainers”, will be part of the ongoing plan to accommodate these additional medical student enrolments. “We are committed to growing our workforce,” Pallister-Coward said. “There is work planned to develop a national infrastructure for training, so that we build a coherent, navigable, national system to support registrars in training. This will include work to support a growth in NZ-trained medical graduates.”
Last week, National Party leader Christopher Luxon announced a plan to open a third medical school at the University of Waikato. Including 50 extra spots at the pre-existing Auckland and Dunedin medical schools, it would cater for an extra 220 students per year. The proposal was met with criticism from some medical professionals who said it ran the risk of adding to existing specialist training shortages unless those issues were addressed. And Fernando said she had the same “bottleneck” concerns for this plan as she did with Labour’s announcement.
National’s health spokesperson Dr Shane Reti told The Spinoff that the training pipeline for the proposed third medical school wouldn’t be needed until 2027. “The clinical placements will include new teaching environments such as Taupo, Tokoroa and Te Kuiti hospitals, associated large medical centres and aged residential care facilities,” he said.“Regional collaboration with at least two other universities is progressing and will also expand the reach for clinical placements and training.”
Reflecting on the situation, Oscar said moving back to Europe made a lot of sense – there would be guaranteed employment, higher pay and family. But, he wanted to put his degree to use in New Zealand, saying, “I’ve learnt all this specialised knowledge about Māori and Pacific communities and then to end up not using it – it’s a beautiful, beautiful thing that I have learned – it would be a shame.”