Dr Michael Bassett: Excessive gate-keeping spoils our health system

The Herald on 30 October led with a story about the Health Minister welcoming fast-track registration for overseas-trained medical graduates to fill critical gaps in our health workforce. Determined, as always, to cry stinky fish about anything the coalition government does, a reporter tracked down critical comments from the salaried medical specialists’ union who denounced the move. The reporter lacked the experience to realise why the doctors oppose the minister on issues like this. What the union wants is more government money spent on its members and their pet projects. It believes that important efforts to save money in the Health sector will almost certainly delay salary increases for them. Scarcity has always worked in favour of higher salaries, so the union wants a gate to stop British, Irish and Australian doctors from filling the gaps in our hospitals too rapidly.

It’s an old gate-keeping trick that has been used by medics over many years. They have invented stories that overseas graduates aren’t sufficiently well trained, and that their credentials need to be carefully checked, even when the newcomers’ qualifications are from the very best overseas training establishments, often better than our own.

I recall one classic case from my time as Minister of Health in the 1980s. A ski resort town in the South Island lacked a general practitioner. By chance a late-twenties German doctor and his wife, who was also medically trained, were keen skiing enthusiasts and had taken a liking to the town. They wanted to settle in New Zealand. The local MP came to me to see whether I could assist them to gain quick registration as doctors. I contacted the Medical Council which was very frosty: no, even although their degrees were from a top-notch German university, and they both spoke good English, they would have to sit exams and it could be twelve months before they started serving the locals. I asked why this was, and was fed an oft-rehearsed line about the need to protect people from inadequately-trained foreigners. At that time, only medical graduates from England, Scotland, Ireland, Australia and – can you believe – apartheid South Africa could get quickly registered here.

Efforts were made after my time to modernise the rules and make it easier for well-trained foreign practitioners. But the Herald story suggests that it has nevertheless become even harder in the interim than it was forty years ago. Only now are graduates from Britain, Ireland and Australia with training in anaesthesia, dermatology, emergency medicine, general practice, internal medicine, pathology and psychiatry going to get their applications assessed within 20 days of applying. No mention of Canadian, American or German-trained doctors.

Areas like the West Coast, the Hutt Valley, South Auckland and Northland currently have dire shortages of GPs. Some places are having to rely on telehealth services. They might benefit slightly, but a long-needed freeing up of the rules governing those trained overseas doesn’t seem to be on the horizon. Sick people will continue to suffer because the Medical Council and the Association of Salaried Medical Specialists want to keep careful control over the gate for their own purposes. What they want is for the government to spend lots more money – preferably on them. And, foolishly, the Labour Party backs them.

Shortages of health practitioners also include the number of nurses available for our hospitals. While the current economic climate requires savings to be made, there are still funded vacancies at many levels of our health services. Anyone who has recently been near a public hospital will know that without nurses from the Philippines, India, China and Europe it couldn’t be functioning. Their training is checked before they are certificated. Why are we so hesitant about doctors?

All of which also raises the question about whether New Zealand is training sufficient nurses and doctors. The answer has to be no. One answer that is being pushed in the Waikato is that a new medical school is needed. But to establish a new one will cost big money. Surely, better to increase the intake of students at Otago and Auckland medical schools. And raise the numbers training as nurses in our universities and polytechs. Such moves will cost less than new schools. But they aren’t likely to get much support from those who see gate-keeping and the scarcities they ensure as guarantees of their own status.

What we also need are reporters who can see what is going on and who then expose those whose years of gatekeeping have denied so many Kiwis the health care they deserve.

Historian Dr Michael Bassett, a Minister in the Fourth Labour Government. This article was first published HERE