A recent media report noted that graduate doctors’ interest in working in small towns and provincial cities continues to decline, adding to ongoing concern about the sustainability of rural health services.
The New Zealand Doctor article went on to say that very few medical graduates want to live and work in towns with a population under 10,000, but rural health advocates point out these communities have increasing health needs as residents age.
The statistics were drawn from the latest Medical Schools Outcomes Database (MSOD) report* that shows only 1.6 per cent of New Zealand medical graduates in 2015 saw small towns as places they wanted to practise.
New Zealand has a long history of trying to incentivise doctors to remain and practice in small towns and rural areas. Many continue to call for incentives (for doctors) despite the historical and demonstrable failure of the many forms of incentives tried.
Alongside the increasing struggle to recruit GPs to many parts of the country is the huge amount spent on GP locums over the years. I personally have no idea exactly how big that spend is, but I can confidently suggest that over our history it has run into many millions of dollars.
Currently there is a push to try and increase GP numbers by establishing a new medical school at Waikato University that will produce rurally oriented GPs. It seems to be based on a similar model at Flinders University in Adelaide which has had success at providing GPs for rural areas.
My questions in response are outspoken and provocative:
- Will producing more GPs actually solve the many problems that confront us in providing primary health care services, be they urban or rural?
- Will more GPs actually change the model of service which, I would candidly suggest, is broken?
- Is an extensive training in biomedicine the best fit with communities’ needs to live well, stay well, die well and to stay out of hospital regardless of income levels, ethnicity and residential location?
These are challenging questions but they need answering if we are to really deliver on the goals of the New Zealand Health Strategy.
We should be very concerned that more and more New Zealanders are experiencing diminished access to health services – or poor quality, poorly co-ordinated care – with different health outcomes for Māori and Pacific, poor or no rural access, rising mental health problems and many other concerns.
We are in danger of becoming inured to such reports as they come so frequently. Whichever way we look, there is a system under severe and growing pressure. Those working in hospitals dealing with the consequences of poor primary health care are under even more pressure.
At least half a million people can no longer afford general practice visits. Many such people in desperation, are currently putting emergency departments under intolerable pressure. At the same time GPs are reporting that their practices are not viable with current funding levels. This situation should not be allowed to continue as it can only worsen under the pressures of an ageing population, increasing levels of long term conditions such as diabetes and kidney disease and the impending threat of anti-microbial resistance.
I feel like a stuck record in noting that one answer is hiding in plain sight.
In New Zealand it costs approximately $600,000 to produce a general practitioner (GP) and $100,000 to produce a nurse practitioner (NP) yet the scope of service is the same.
Registered nurses are widely distributed around the country in rural, remote and urban areas. Evidence shows they are inclined to remain in the areas where they begin practice. Evidence now shows that approximately 4000 nurses have a clinical masters degree and many would not be far off seeking NP registration if encouraged with minimal further investment.
There is a long overdue need to stop the repeated calls to educate more GPs and instead divert substantial investment towards developing some of the existing nursing workforce to nurse practitioner level. Doing so would provide a rapid, cost effective, completely safe and highly accessible solution to the problem.
There are already nearly 300 NPs in New Zealand, half of whom are providing primary health care services.
I would urge more careful consideration of this health workforce solution which is right under our noses.
*National report on students graduating medical school in NZ in 2015, NZ MSOD Steering Group
Author: Professor Jenny Carryer RN PhD is executive director of the College of Nurses. This article will also be published in the next print edition of Nursing Review.