This afternoon, members of the New Zealand Medical Association voted six to one to liquidate, driving the final nail into the coffin of an organisation that’s been part of this country’s medical landscape for 136 years. Jules Older explains how we got here.

When they opened their emails on May 6, some 2,000 New Zealand doctors got a high-voltage shock. Barring a miracle, the venerable medical organisation they belonged to was about to die. In three short weeks.

The organisation apparently in its final hours is — was — the New Zealand Medical Association (NZMA). Founded in Dunedin in 1886, it has been a New Zealand presence ever since. Until 1967, the NZMA was a branch of the British Medical Association; since the 1970s that subservience reflected what a growing number of more progressive doctors considered its conservative, anglicised leanings. But in or out of favour, the NZMA was the organisation that endeavoured to speak for all physicians, general practitioners and medical specialists alike.  

Adding to the shock of the announcement, both the chair and the entire board of directors recommended that members vote in favour of organisational death. 

The message read in part: 

NZMA Board Recommends Liquidation

The NZMA Board met last night and unanimously agreed to recommend that members vote to liquidate the Association at a rescheduled Annual General Meeting.

A recent close examination of the Association’s budget and cashflow projection has shown that the financial situation of NZMA is dire, and urgent. The NZMA constitution requires that a resolution to liquidate is approved by members at a rescheduled Annual General Meeting on 30 May 2022 and confirmed at a follow-up Special General Meeting.

The announcement was signed by Dr Alistair Humphrey, NZMA chair, and Dr Vanessa Weenink, NZMA GP council chair. 

And that wasn’t all. Not only would the organisation die, it could take the country’s best-known medical journal, New Zealand Medical Journal, with it to the grave. The journal also has deep roots, beginning publication in 1867 and still active today.

The question that’s roiling the medical community is this: Did its leaders kill the NZMA by making bad decisions, or did they simply smooth the pillow for an already dying organisation? The former was preventable; the latter, inevitable. Doctors across the motu hold strong opinions on the cause of death.

A number of New Zealand medics had long ago cast their ballot for death-by-irrelevance. They’d never joined NZMA or had long ago dropped out. 

• A surgeon: “I have not played any active part in the organisation and didn’t go to meetings.”
• An epidemiologist: “It is many years since I was a member of the NZMA.” 
• A general practitioner (GP): “The few times I attended, it never felt like home.” 

Bruce Arroll believed the NZMA had simply outlived its usefulness. Arroll is professor and head of the department of general practice and primary health care at the University of Auckland. “It’s not a union for medical specialists and not one for GPs,” he said. “It doesn’t have a significant educational role. Other than running the medical journal, it had no purpose, sadly. I’m amazed it went for so long.” 

The first words out of Ian Powell’s mouth were, “I’m not a doctor.” True, but when it comes to medical organisations, he knows where the bodies are buried. He should. From 1989 through 2019, Powell was executive director of the Association of Salaried Medical Specialists. The ASMS is the union representing salaried senior doctors and dentists. “As ASMS grew, NZMA’s membership dropped. I don’t think that several years of their elected leadership grasped this — the board was in a state of denial,” he said. “They thought they could still get by; they had their Wellington building and the medical journal. And belief in a magic bullet.

“But their membership loss was increasing. Making matters worse, they discovered that their building, NZMA House, was an earthquake risk. They could sell it or rebuild. They decided to rebuild — as a renting proposition. But renting was more difficult than they thought, especially with Covid.”

There were other issues as well. Powell believed NZMA had long-fudged its membership numbers by including medical students. “I think by now they’d be lucky to have 2,000 members out of the 18,000 actively practising doctors in New Zealand.” Earlier this year, said Powell, 60 or so members didn’t renew their subscriptions and weren’t chased up, even by phone. “They also should have approached the World Medical Association for advice and should have consulted past leaders as well. And they should not have treated liquidation as the only option.” 

Epidemiologist Michael Baker attributed the declining membership to a problem of image. “When I was in med school, the NZMA seemed a conservative and backward-looking organisation that resisted important reforms to the healthcare system,” he said. “In recent years, I think they have become more progressive on public health issues, but as recently as 2018, NZMA opposed the End of Life Choice Bill.”

Like others, Baker was alarmed by one potential consequence of today’s vote: “The end of the NZMA could be bad news for the New Zealand Medical Journal which has a fantastic history of publishing material critical for improving health care and public health in New Zealand,” he said.

Baker’s description of the NZMA as conservative, backward and reform-averse is reflected in the experience of Don Matheson. Otago-trained and now an adjunct professor in the department of medicine at Griffith University in Queensland, Matheson recalls, “As a young doctor, I learned first-hand that the NZMA behaved in ways consistent with maintaining their position in the market rather than being driven by a sense of compassion. In 1989, the NZMA took a case against me for ‘bringing  the practice of medicine into disrepute’.”

What crime against medicine led to this action? “My offence was working in a high-needs practice that had abandoned user charges and replaced them with koha of the patients’ choosing.”

in response to the charge, “I contacted my professional insurer (run by the NZMA!) and they advised me to seek advice from England.” The advice from England was that the charges being brought by the NZMA were ridiculous. Matheson was authorised to enlist a leading QC, which he did. Before things progressed, a new chair was elected to the NZMA, Alister Scott. Soon after he took office, Scott called Matheson to his office and put an end to the matter. “This change of direction started by Alister was obviously maintained, as evidenced by the NZMA’s policy statement on health equity published 20 years later.”

The NZMA leadership was approached for comment multiple times for this story. They did not respond.

Barbara Fountain, editor of New Zealand Doctor, expressed the mixture of feelings of many New Zealand physicians about the organisation’s collapse. In an editorial, she wrote:  “I was shocked by the finality of the announcement from the board — and the lack of a heads-up for members. But I was not surprised. The NZMA has been coy about its membership for quite some time. Ultimately, membership organisations cannot exist without members. It may be that the NZMA has served its purpose and irrespective of its long history, its time is spent.”

After the votes of its members, on the advice of its board, the NZMA is no more.