Well in short everything you have heard about working the US is true. They work long hours, the pay is average but livable, days off and holidays are not so many and they like ordering tests. When talking to international medical graduates coming to the US about their reason for coming, the answer is universal answer  – training. There is a culture of teaching and learning. Every day there is one to four hours of teaching, rotations are one month long to give more exposure in a condense program length. Services are intern-led with senior residents providing supervision along with Attendings (consultants). The health system is a story of two tales. On one hand you have the largest most specialized hospitals in the world offering the latest procedures and opportunities for cutting edge research. Then on other end there are vast amount of Americans with no insurance and the plight of the homeless and destitute is one of the most depressing things to watch in this land of excess. There is no doubt that more tests and imaging is ordered here but what is different is that the patient expectation is very high and under the litigation system, doctors have little room to miss things. Training settings vary from University hospitals, community hospitals, large County (public) hospitals or medical practices. Medical students in the US go directly into the specialty they choose after graduation, so New Zealanders generalist skills are well appreciated by most US clinicians. Training is shorter here between 3-6 years, though it is more intense and there are standard board exams and regulated program requirements.

Reason for coming

Coming to the US for post graduate training has both pros and cons, these need to be addressed by each person and more importantly long term goals need to be looked at to see whether this option is worth pursuing. Looking into where you want to live long term and how qualifications are accepted back in NZ and other places is important to investigate.

When to come

Planning is crucial. Again reviewing what your long term aims are, will dictate when best to train in the US. Traditionally New Zealanders have used the UK and the US for post fellowship training. Without fellowship you have to enter the MATCH and do a residency after gaining EFCMG (Foreign medical graduate accredited) status by sitting the USMLEs. (US medical exams)

Options for training

A full list of residencies and fellowships are listed on FRIEDA which is a electronic database. There are other fellowships that are not listed here and would be have to be searched on individual hospital websites.

Frieda

http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online.shtml

What to do

All medical graduates must do the USMLEs, although for residencies the grades need to be higher. For residency letters of references (especially from the US) and observerships are important. The full process is outlined in the below websites.

www.usmle.org

www.ecfmg.org

This link is by an Irish doctor who matched in 1999 and is at Harvard is one of the best I have read.

http://www.internationaldoc.com

Summary

The US is option for post graduate training. It’s one that has to be weighed up for each person. It’s not for everyone and NZ offers world class fellowship training, but for some it offers opportunities not available in NZ and to bring these skills back home.

Xaviour Walker

Internal Medicine Resident

Mount Auburn Hospital

Harvard Medical School

Emerging markets are changing the way the world works by developing into global powerhouses.

Rapid economic growth

Over the next 5 years growth in emerging economies is still expected to outpace the developed world. This growth is fuelling increases in household incomes in places like China and India where nearly 60 million people are joining the ranks of the middle class each year.

High savings rates in Asia

Despite rising consumption, households in emerging Asia save 17 percent of all disposable income, that’s roughly four times the savings rates of the US and much higher than the average for the developed world. High savings rates means less borrowing at all levels and strong support for investment in capital markets.

Urbanisation

The world’s urban population is growing by more than 70 million people each year. China already has over 100 cities with 1 million people and is expected to have over 200 of them by 2025. This urban migration has overwhelmed existing infrastructure like roads, railways, sanitation and electrical services. The development of this critical infrastructure will require vast amounts of copper, steel, concrete and increase the demand for all commodities.

Desire for social stability

Governments need to provide opportunities for people to improve their quality of life. Many governments have found the key to social stability is focusing on job creation which establishes a path of upward mobility for citizens.

Natural resources wealth

Many of today’s most promising emerging nations sit atop some of the largest oil, metal and other valuable resource deposits in the world. Many of these nations have teamed up with private and/or foreign enterprises to bring these resources to market. Revenue generated through taxation and direct ownership allows for these governments to build infrastructure, create jobs and pursue other economic opportunities.

Corporate transparency

A history of corruption and political turmoil has given way to higher standards of corporate governance in today’s globalised world. Though still far from perfect, the improved transparency and oversight has made important information available to investors and reduced uncertainty. By aligning themselves with international business standards and requirements, emerging nations will attract more foreign capital and better integrate themselves into the global marketplace.

Further enquiries, please contact:

Roger Sutherland

Director, Grant Thornton Wealth Management Ltd

T +64 (0)9 308 2974

E roger.sutherland@nz.gt.com

Issued on: 31 August 2010

A couple of things struck me. Firstly, whilst we heard from consultants, senior registrars, a medical recruitment agency representative and the Chair of Health Workforce New Zealand, the voice of medical students and junior doctors was disappointingly, and yet typically, marginalised. Absent even. As is too often the case, the nation was not exposed to the direct views of those who comprise the principal population of concern and the future of our health workforce. How can we hope to understand, and subsequently effectively address the real underlying issues if we are not even communicating or engaging with the particular group of individuals that we are allegedly hoping to retain within our system? This programme’s content is sadly reflective of the general approach evident within our country: the (politically-driven) opinions of frighteningly few yet powerful senior figures are clearly audible and given their due weight. However, this does not appear to be ‘countered’ by the voice of the junior doctor.

It does not take a genius to acknowledge that simply stating something does not make it true and, I’m sorry, but I do not agree with the assertions provided by Health Workforce NZ representatives as to why our system is positively haemorrhaging skilled medical staff. These assertions do not stem from valid, inclusive or recent research and do not accurately reflect the views and experiences of my clinical colleagues. The failure to communicate these views is the result of both a lack of understanding around the real reasons underlying the current shortages, but also inadequate commitment to the discussion and dissemination of this important information. Here, each of the journalists, those tasked with addressing the issue (the Clinical Agency Training Board) and also, vitally, the junior doctors themselves bear the responsibility for this failure.

If we want to improve our system, we must play our part. This means getting involved and voicing our opinions. We must insist that we are heard. This includes identifying where we are not represented, or where we are in fact perhaps misrepresented. To use a familiar analogy, we would not dream of treating a patient’s medical condition without first talking to the affected individual. And yet when we consider the issue of junior doctor attrition, it often seems that we are missing this essential step – the one that facilitates the deepest understanding of the issue at hand. On that note, could someone please clarify how and to what extent junior medical staff have a role and involvement in the work of Health Workforce NZ? For now, I remain unconvinced that this is a collaborative process.

Secondly, Prof Gorman’s labelling of NZ junior doctors as “mercenaries” was stunning. It seems incredibly rich for a leading representative of a system that actively recruits significant numbers of international medical staff to criticise the loyalty, and even the fundamental ethics of it’s own junior staff. I very nearly dislocated my jaw: such was the speed at which it dropped upon hearing this comment. The claim here was that junior doctors ‘owe’ the country, as there has been substantial investment of resource into their training. I accept without question that a significant amount of time, effort and fiscal resources are devoted to the training of medical doctors and, to an extent, believe that there is a certain amount of (implicit) obligation here. But that is certainly not what caused the aforementioned jaw drop.

Our medical system is currently 40% staffed by doctors who have been trained, and therefore have been extensively financially supported, by other nations. Again, NZ actively recruits these individuals to meet our shortage. We do not seem to have any ethical issue effectively poaching staff from other countries, many of which are less able to afford the loss of their medical personnel, due to even lower physician density. We have done it for years and it is unlikely that this practice will dramatically change in the foreseeable future. Have we considered financial compensation to the countries that have trained these individuals? No. We welcome these skilled individuals with open arms and continue to recruit still more. And, as we do that, we simultaneously publicly criticise the NZ trained doctors who decide to leave our shores. Put another way: we can take it (and how), but we can’t give it out. It is hypocritical. And it comes across as downright arrogant. We would be wise to consider our comments about the ethics of the brain drain much more carefully, particularly in the context of NZ’s long-standing and shocking reliance on those who have been supported by other governments.

Aside from the sheer hypocrisy of this comment, I also have to question the tactics employed here. If the aim is to improve retention, perhaps criticism (in a very public arena) and unfair labelling are not the way to go. The levels of disengagement are already high, as is the degree to which feeling undervalued is a significant issue within the junior doctor population. Failing to adequately involve junior staff in discussions around reducing the rate of attrition and failing to accurately interpret their concerns do enough to inhibit the level of trust. Adding what are effectively attacks into the mix just does not seem smart and it certainly makes me question the vision and credibility of the approach employed by this Taskforce.

It should not be about scoring what are essentially cheap political points. It should be about addressing the problem at hand. So, let’s see about doing just that.

It struck me however, that there are plenty of ‘networks’ at play within a healthcare setting. For example – we all form part of a team within the specialty we work in, but we’re also generally part of a wider team that includes nurses, OTs, phyisos, pharmacists, dieticians etc. Our immediate teams interact with other teams from the same and different specilaties. The web gets more and more complex the more you think about it.

Now add some technology into the mix and the network explodes – email, forums, web based technology increases the ability to communicate and share information within healthcare enormously. Suddenly, geographical barriers and separation no longer come into play to the same extent.

So – there is so much opportunity for ’connectedness’ and yet if we reflect we’ll probably find that we still tend to operate in silos. Why is this the case?

As with other complex systems, the answer is multi-factorial and I’ll probably need to leave exploring that issue to another blog. For now though, give the networks you operate in and form part of a thought and think about how we can better use our networks to improve patient outcomes and the care we offer our patients. We are part of a massive socio-technical network, lets actually use it!

Should doctors be paid as per patient outcomes:

• $3000 fee = a patient has a complication-free appendicectomy and discharged after 3 days hospital stay.
• $2000 penalty = patient has surgical complication requiring readmission for wound infection requiring IV antibiotics.

This is a marked shift from current systems and on the surface this may seem like a crazy system – but I feel this is the way our health systems have to evolve.

I come to this conclusion by analyzing the current incentives to work as a doctor in New Zealand…..

Money: We get paid, and so we turn up to work. We get paid more the more we can do, and hence we train more and specialize.

Altruistic: We have all said the oath, and hence we are ‘really’ only interested in doing good and helping people (not the money) – slight hint of sarcasm (previously I have written about our general lack of doctors ability to recall the Oath).

Regardless of what your incentive is, the end goal should be for quality patient care.

All other professional careers (lawyer, accountant, engineer, banker etc) are rewarded for good work. However, poor work is not tolerated and financial incentives are such that you are unlikely to get paid or be successful if you make errors in your work (eg. if you are a lawyer that loses case after case, you aren’t going to attract many clients).

Is healthcare like this? I suspect healthcare in general gets away with less accountability than other professions. The industry is such that there is increased public tolerance for poor performance or lack of progress then other industries. I guess this arises from the intimate personal connection with ones’ health and the inherent respect and trust for doctors.

However, I believe this is not the best system to develop quality and progressive systems in healthcare. Imagine a world where doctors are given bonuses for doing things well and finding new ways to do treat things better. Surely this is a better way to push up quality and drive down costs, and most importantly, treat patients better.

Conversely, penalties for poor or substandard care would mitigate things which don’t need to go wrong. In NZ doctors are protected from doing things wrong by ACC and indemnity insurance. In the US and Australia (to a lesser extent) there is the additional threat of litigation.

I feel that such a model ties together the incentives for doctors of financial reward and patient focus.

RMOs would be incentivized to see patients in ED quicker, discharge patients faster, provide treatment with minimal pain etc, and all whilst keeping the patients satisfaction at front of mind.

Additionally all health workers would be on the look out for ways to do things better, in hope of financial rewards, as well as mitigating bad events. We would be less dependent on expensive and time-consuming research by doctors and private companies as the primary ways for development of new technology and processes. The hospital would become a breeding ground for doing things better – for the patient!

Surely this is a model of the future. Obama thinks so and the US Healthcare Reform is developing new structures called Accountable Care Organisations, which are much like NZ PHOs and DHBs which are responsible for care for a fixed amount of money. Perhaps the US can learn from NZ.

Have you got thoughts on this? Please share below.

My decision to pursue a career in the medical profession was one that was formed over weeks rather than years, but once the goal had been set, I remember how fiercely it held and how quickly this dream grew to almost consume me. At that time, all I wanted and almost all I could think about was getting into medical school. I practically fantasised about owning my first stethoscope and even the simple act of walking past a hospital or healthcare centre started to take on special significance. Yes, part of this was simply down to having an objective and wanting to attain it, but I now realise just how much passion lie beneath my thoughts and actions. I just desperately wanted to be a doctor. Though many of us play it down, we can’t deny that this is a profession that can surely stoke the fire in your belly!

I see my friend study and listen to her vocalise her doctoring dreams, and am quietly reminded of the privilege and opportunity that we have been afforded. I reflect on how many people have had this very same ambition, and how lucky we actually are to have had the chance to realise it. Yes, we probably deserved our seats in the medical school lecture theatre, but this does not discount the fact that we were still at least somewhat lucky to have held them. They were and are valued, highly sought after positions. I am reminded how excited I once was about even the thought of the job. I am reminded how I once could not wait to set foot in a hospital and change someone’s life for the better. Even in a small way. I did not need to be convinced that the sacrifices would be worth it. I just knew they would be. Somewhat painfully, I recall how I once vowed that I would not turn into one of those cynical practitioners and that I would continue to cherish the responsibility that came with my position.

I’ve been reflecting on how my views on and approach to medicine changed and developed over the years. I grew up, at least a little bit and you may be pleased (and somewhat relieved) to hear that my astounding levels of naivety and idealism have truly settled. But, more than that I recognise how quickly and almost effortlessly I settled into the doctor ‘routine’ and neglected to remember the passion that was actually there. Feeling tired, overwhelmed and harassed by the workload was so much easier than being excited. Feeling underappreciated was so much easier than remembering that so many others could have been in our place, and that they would be so thankful for that opportunity.

I know that the ‘magic of medicine’ is still there – I don’t think it will ever leave me. Just sometimes I have to work a little harder to ensure it doesn’t hide itself away from my daily practice.

For all the pain, work, agonising frustration and occasional tears, it is a great job and an amazing profession – one full of challenges, opportunity, stimulation, satisfaction and inspiring collegiality. Looking through my friend’s eyes has encouraged me to take another look at my job through my own eyes, temporarily readjust my lenses back around 10yrs and be reinspired. And grateful. Every so often, I encourage you all to do the same.

Friday 23 July 2010

IN THIS ISSUE

• NZMA position on euthanasia
• Message from ACC for GPs – sensitive claims
• NZMA notes passing of Sir Randal Elliot
• Message to all GPs and practice managers
• Changes to Section 88
• New workplace laws and medical certificates
• Medical student debt
• Pharmac role extended – NZMA response
• Final reminder: Auckland Council Event 27 July

NEWS

NZMA position on euthanasia
The NZMA has fielded many media inquiries on the issue of euthanasia this week. Media interest has been in response to the public challenging by former North Shore GP, Dr John Pollock, who has terminal cancer and is advocating for legalised voluntary euthanasia in New Zealand. NZMA Chair Dr Peter Foley has conducted numerous interviews stating the NZMA’s position, which is in line with the World Medical Association and almost all international national medical associations, which opposes euthanasia* and doctor assisted suicide as unethical. The NZMA is not against individuals having a choice said Dr Foley on TV One’s Close Up programme. “What we are against, is then involving the doctor, in assisting the outcome of the choice.” In interviews, including in last night’s Close Up where Dr Foley appeared alongside Dr Pollock, he was able to emphasise to him the availability of effective palliative care to manage pain relief and alleviate suffering in end of life care. To read the NZMA’s position statement on euthanasia go to: http://www.nzma.org.nz/news/policies/euthanasia.html

*Euthanasia is “a deliberate intervention undertaken with the express intention of ending a life”. (House of Lords Select Committee on Ethics)

*It is not to be confused with good quality palliative care delivered to relieve suffering and pain in a terminally ill patient’s final stage of life.

Message from ACC for GPs – sensitive claims
ACC is asking GPs to provide more information when they submit claims for patients who have been sexually abused or assaulted. Previously GPs were simply required to indicate a sensitive claim on the ACC45 form. But ACC’s new Clinical Pathway for patients whose sexual abuse or assault has caused a mental injury relies on early diagnosis, to provide timely and targeted treatment. ACC’s Dr Peter Jansen says GPs can help patients by providing as much detail as possible of the nature of the events and of the suspected mental injury, as well as any other relevant clinical or psychosocial information.* By sending this information ACC can give faster consideration of the claim. For more information contact sensitiveclaims@acc.co.nz

*The NZMA can confirm that work is continuing on better ways for this extra information to be supplied, and for appropriate remuneration for the extra effort required to help your patient.

NZMA notes passing of Sir Randal Elliot
The NZMA noted with deep regret the passing of Sir Randal Elliott, KBE, MB ChB (NZ) 1947, RCS&P DO 1949, FRCS (Oph) Eng 1953, FRACS (Oph) 1953, FNZMA 1976, FRACO 1982. During his long career, which commenced with his graduation from Otago Medical School in 1947, he was recognised as one of New Zealand’s most distinguished doctors. Sir Randal was acknowledged as a prominent leader in health circles, and held the highest offices within the NZMA, as chairman in 1971-72, and President in 1977, which was also the year he received his knighthood.

Message for all GPs & general practice managers – update from last week
You will have recently received a letter regarding a possible future charging for the MIMS interface with your PMS system. This letter proposed that you sign up for a new fee for this service, and asked for important information about your practice. Our firm advice remains not to respond to this in any way until you receive further advice from us as we continue to meet and work towards a sensible resolution to this added expense to general practice.

Changes to Section 88
Thank you to the members who responded to the request for feedback on the recently announced Section 88 termination. Your comments will be incorporated into the NZMA’s advocacy on the issue.

New workplace laws and medical certificates
NZMA GP Council Chair Dr Mark Peterson was interviewed by Radio NZ and other media outlets about the impact of the Government’s workplace laws that allow employers to demand medical certificates from the first day off, rather than after three days as is currently the case. Dr Peterson said most general practices were unable to offer same-day appointments and it would require people to unnecessarily visit their doctor for minor ailments, such as colds, which were most often self-treated. We would expect that a sensible rethink on this Government proposal will see that it is both unnecessary, and unworkable, to involve the medical profession in this employment issue.

Medical student debt
An article that appears in the latest issue of the NZMJ ‘Taking the pulse: medical student workforce intentions and the impact of debt’ generated significant media coverage. The article says that 52 per cent of medical students planned to leave the country within two or three years of graduation. Debt was a major factor in their decision followed by the view that they would not be valued by hospital management or the Government. To read the NZMJ article go to: http://www.nzma.org.nz/journal/123-1318/4212/
NZMA Chair Dr Peter Foley was interviewed in the media about this article, and was able to stress both the debt factor and the very important problem with the perceived learning and working environment in many parts of New Zealand.

Pharmac role extended – NZMA response
Pharmac is to extend its role of managing and procuring community pharmaceuticals and will now buy and manage hospital medicines as well. The change was recommended in last year’s Ministerial Review Group report to achieve value for money as well as ensure national consistency so that patients obtain equitable access to treatments no matter where they live. The NZMA supports this extension to Pharmac’s role as sensible and cost-effective but is concerned about the Pharmac model being used in the management and procurement of medical devices. NZMA Chair Dr Peter Foley, speaking on today’s Morning Report programme, said the current Pharmac model cannot easily be extrapolated to procurement of medical devices.  The NZMA has provided advice to Pharmac and Dr Foley says they understand our concerns. To hear the full interview:

Medical Association concerned by Pharmac buying medical devices

Final Reminder: NZMA Auckland Council event
The NZMA Auckland Council invites Auckland doctors to an exciting event – the great NZMA/medical school debates. The moderator for the debates will be Dr Paul Hutchison, Chair of the Health Select Committee, a very experienced parliamentary debater and MP for Franklin.

When: Tuesday 27 July 2010
Where: Auckland Medical School, Robb Theatre.
Time: Drinks, canapés and socialising from 6.30pm. Debates commence 7.30pm.

The event will be opened by Professor Iain Martin, Dean of the faculty of Medical and Health Sciences. Members of the debate teams will include medical students Craig Riddell, Zach Kidman, Andrew McDonald and Sudhvir Singh; RMOs Anna Dare and Pete Storey; and seniors Dr Stephen Child and Professor Harvey White.

Please RSVP by Monday 26 July to Falyn Edlin: falyn@nzma.org.nz or phone 04 472-4741.

NZMA ACTIVITIES

• NZMA Chair Dr Peter Foley and NZMA CEO Cameron McIver appeared before the Health Select Committee on Wednesday to elaborate on our submission on the Public Health and Disability Amendment Bill. To read the NZMA submission go to: www.nzma.org.nz/membersonly/submissions.html
• Dr Foley attended the Otago Division AGM on Wednesday evening where he formally presented Dr Sue Hayde, a former NZMA Specialist Council Chair and NZMA Board member, with an NZMA fellowship for her years of dedication and commitment to the NZMA. The fellowship was announced at the NZMA’s end of year awards event last year but Dr Hayde had been unable to attend due to her clinical commitments at the time. The Otago AGM was extremely well attended, and the Division is very active. Dr Don McKenzie was re-elected as Divisional President.
• Dr Foley has been interviewed on TV One’s Close Up, Prime News and TVNZ 7 this week about euthanasia (see first NEWS item).
• Dr Foley has also been interviewed this week on changes to Pharmac’s role, medical student debt (see NEWS items) and treatment injuries in our hospitals.
• Dr Foley, Dr Peterson and Mr McIver are attending the World Health Care Networks Conference in Auckland 22-24 July.

EVENTS

Register now – NZMA GP CME conference South Island
The first ever South Island NZMA GP CME conference is being held in Christchurch from 5-8 August, and follows on from the highly successful NZMA GP CME conference in Rotorua in June. Registrations have already been received by more than 250 delegates. The conference focuses on short, sharp and to the point clinical updates to change practice behaviour immediately. Sessions cover a diverse range of topics, including: optimal breast cancer screening, fracture management, smoking cessation strategies, how to interpret ECGs, bipolar disorders, travel medicine case studies, hands on ultrasound in general practice and musculoskeletal radiology. The conference is endorsed for CME and MOPS purposes by the RNZCG.
View the full programme and register at: http://www.gpcme.co.nz/south/index.php.
For more information please email Leon Olsen at Conference Matters or call 021 164 3815.

NZ Healthcare summit
Hyatt Regency, AUCKLAND
10-11 August 2010
With current reforms and growing demands, healthcare is very much on everyone’s agenda! This two day event focuses on key issues in the funding, development, management, and productive use of New Zealand’s healthcare resources. It features presentations from representatives of government and the healthcare industry including: government departments and agencies; District Health Boards; hospitals; Primary Healthcare Organisations; GPs; private health providers; and industry associations.

NZMA Chair Dr Peter Foley will deliver a presentation (Tuesday 10 August 2.10pm) at the summit on “Rationalising and funding of primary healthcare.” Keynote speakers also include: The Hon Peter Dunne Associate Minister for Health, Geraint Martin Chief Executive Officer Counties Manukau DHB, Faye Sumner Chief Executive Officer Medical Technology Association of NZ and Matthew Brougham, Chief Executive of PHARMAC.

Full program and registration details are on the event website at: www.activebusinesscommunications.com/health2010 or call Anthony Sprange on 09 280 3330.

RNZCGP conference
CHRISTCHURCH
2-5 September 2010
The 2010 conference, “Doing the right thing,” takes place 2-5 September 2010 at the Christchurch Convention Centre. Thursday 2 September is research day. This is a full day symposium focused on research in primary care. On Friday, Saturday and Sunday, 3-5 September 2010, there will be a mix of concurrent sessions, workshops, practical clinical skills sessions and plenary sessions. This year’s conference includes keynote presentations from Iona Heath, President of the UK Royal College of GP’s, a therapeutics initiative presentation by James Mcormack and Mike Allan from Canada, and Graham Stokes, a mental health specialist will be discussing dementia. Full details are on the conference website: www.rnzcgpconference.org.nz.

19th Hospice NZ Palliative Care conference – Navigating the Journey
WELLINGTON
9-11 November 2010
“Navigating the Journey” will showcase the ways in which members of the wider healthcare community work in partnership with patients and their families. International and local leaders in the field of palliative care will share their knowledge with us over the three day conference, focusing on innovative clinical developments, best practice, education and research. The call for abstracts is currently open – submissions are welcome from anyone interested in presenting at conference. For more information: http://www.hospice.org.nz/conference-2010.

MEMBER BENEFIT

Legal expenses insurance
Wilkinson Insurance Brokers in conjunction with NZMA offers Legal Expenses Insurance (underwritten by Lumley General Insurance) to protect medical practitioners against the expenses of facing legal action related to the running of their businesses. Members receive a 15% discount.  It covers a wide range of disputes such as those relating to employees or employers, commercial contracts, partnership agreements and tax audit. Contact Membership Administrator Susan Holt susan@nzma.org.nz for more information.

MEMBER ADVISORY

The Protected Disclosures Act 2000
This Act, commonly known as the whistle-blowing legislation, is designed to address the difficult position people find themselves in when they become aware of what this Act refers to as “serious wrongdoing”. This legislation arose out of the 1994 case of a Wanganui psychiatric nurse who was first suspended and then dismissed for disclosing his concerns about the danger posed to the community by releasing a patient from Lake Alice Hospital. The effect of the Protected Disclosures Act can be summarised in a single statement: Certain legal rights and protections will apply to employees in organisations who make disclosures in accordance with the Act about serious wrongdoing in or by that organisation. The Act provides these protections in order to encourage disclosures. This in turn enables the serious wrongdoing to be investigated. The NZMA Member Advisory Service has a member resource on the main aspects of this Act – it is applicable to both employee and employer members alike. Download this from our website at http://www.nzma.org.nz/membersonly/advisory-service.html or email Debbie Papera debbie@nzma.org.nz for a copy.

Vital Signs is a weekly email bulletin with news and information about the NZMA. It aims to keep members in touch with the NZMA’s work, and complement the NZMA newsletter Medspeak and website. If you do not wish to receive Vital Signs, please reply with the word “unsubscribe” in the subject line. Daphne Atkinson
Communications Manager, New Zealand Medical Association (NZMA)
PO Box 156, Wellington, Tel: (04) 472 4741, Fax: (04) 471 0838
Email: daphne@nzma.org.nz
Visit our website: www.nzma.org.nz ]]> http://www.scrubs.co.nz/blogs/nzma-vital-signs/nzma-vital-signs-530/feed/ 0 http://www.scrubs.co.nz/blogs/medicine-and-beyond/medicine-and-beyond-22-the-%e2%80%98language%e2%80%99-of-medicine/ http://www.scrubs.co.nz/blogs/medicine-and-beyond/medicine-and-beyond-22-the-%e2%80%98language%e2%80%99-of-medicine/#comments Tue, 20 Jul 2010 00:16:34 +0000 Scrubs Team http://www.scrubs.co.nz/blogs/?p=535 We were in a foreign European city a few weeks ago and were involved in assisting in a medical emergency. The experience highlighted a key issue for me and one that we often take for granted in the workplace… the ability to communicate with patients and other health professionals! Our patient was French and was travelling with a French friend, the security assistants at the site we were visiting spoke broken English, but were Dutch, as were the ambulance crew of course when they arrived. Another health professional on the scene was Spanish…..]]> We were in a foreign European city a few weeks ago and were involved in assisting in a medical emergency. The experience highlighted a key issue for me and one that we often take for granted in the workplace… the ability to communicate with patients and other health professionals!

Our patient was French and was travelling with a French friend, the security assistants at the site we were visiting spoke broken English, but were Dutch, as were the ambulance crew of course when they arrived. Another health professional on the scene was Spanish…..

The scene that ensued would have looked quite comical I think had there been an ‘external’ observer – everyone clearly trying to do their best for the person in need, but really struggling to coordinate and communicate with the others who were trying to be helpful in the situation – all because we didn’t speak the same language!

The patient was fine in the end, but the real importance if being able to communicate within teams was really highlighted! Be sure to communicate with your patients and their families as well as your colleagues – when you can’t, practicing medicine becomes very difficult!

Take your current level of income and multiply it by 70%. That’s what many people say they will need as a minimum to have a comfortable lifestyle in retirement. On top of that you will also need to allow for one off items such as replacing the family car every 5 years or so, as well as the occasional offshore adventure.

Healthier lifestyle choices and continual improvements in our medical care mean we are living longer, so our retirement provisioning will have to last a little longer than maybe it did for your parents

So let’s assume you are currently earning a good income of $200,000 pa. Applying the 70% ratio above then a typical retirement income would be $140,000, before tax. When we factor in the new tax rates effective from 1 October this year that will provide an after tax income of approximately $ 97,250 pa based upon a single person, or if you can income split with your partner then that increases to $107,700 pa net.

Of course under current rules you will get some help from the Government in the form of NZ Superannuation. Upon attaining 65 years of age you will receive a net figure of $16,542 pa if you are single and living alone, or if you are married $12,724 each pa. reducing the amount you will need to fund yourself to somewhere between $80,700 and $82,250 pa.                                         .

Next you need to make some decisions about your retirement capital. Do you want to have built up sufficient capital so that under normal market conditions it will comfortably produce the $80,000 – $82,250 shortfall year in year out leaving the capital base intact for future generations, or are you happy to consume a little of your capital base each year along the way.  If you do that you will still have the “lifestyle” assets to leave to the children which usually consists of the family home and the beach property.

So how much “retirement capital” will you need by age 65 years?

To do this calculation first we need to make some assumptions, such as typical earning rates, the period of retirement and as mentioned above whether that capital base can be used as you go or needs to stay intact.

By way of example:

$140,000 less tax (married couple)                                                     $107,700

less NZ super entitlement  (married couple)                                       $  25,449

Income to be provided from your own sources pa                             $  82,251

Assumed earning rate after tax, inflation and any other expenses say 3.00%

Period of retirement (65 yrs to 90 yrs )                                               25 years

Amount required by age 65 years if capital to be consumed             $1.4 million

Amount required by age 65 years if capital not to be consumed       $2.7 million

Next issue we will look at what sort of savings rates need to be established to reach these sorts of financial goals. In the meantime to see if your retirement planning is on track arrange for a complimentary financial checkup with your Grant Thornton Business advisory Partner or contact your local Grant Thornton Wealth Management Director today.

Fundamentally for businesses, the enigma faced by government was how to balance the “big brother” comparisons with Australia, significant constraint through falling revenues and increasing expectations with the need to set businesses on the path to recovery.

Overall, the government has delivered a broadly neutral package for business.

In a surprise move to remain competitive with our neighbours New Zealand has finally got one up on the Australians by reducing the corporate tax rate to 28% from the 2012 tax year (generally April 1, 2011), a full year ahead of a similar move by the Australian government in its budget released earlier this month.

Unfortunately, if businesses are not currently making money the tax rate reduction won’t provide any immediate relief but does give a signal to the future of businesses as they move to profitability.

Likewise, to ensure the proliferation of foreign business ownership in New Zealand companies pay a greater share of tax in New Zealand, the thin capitalisation rules have been strengthened. Thin capitalisation refers to the extent to which a business is funded through debt rather than equity. Debt reduces New Zealand corporate tax liability (at 28% under the announced changes) replacing it with a withholding tax cost of 10%. The ratio of debt to assets has been reduced from 75% to 60%, meaning 18% more tax will be paid on 15% more profits earned by foreign owned businesses.

One of the key question marks is the effect other measures in the budget will have on businesses. Those measures include the increase in GST rate to 15% from 12.5% from October 1, 2010, the removal of depreciation from all buildings from the 2012 tax year, the removal of the 20% accelerated loading on deprecation on plant and equipment on all new acquisitions from budget day, and the reduction in personal tax rates.

While the increase in GST should be directly neutral on businesses, other than those involved in the supply of exempt services, the effect on consumer behaviour on these businesses is less certain. It is likely that an amount of knee-jerk consumer spending will result in the lead up to the change in GST rate which businesses will gear up for.  The extent of the post-GST blues is less certain, particularly running into the traditional Christmas spending spree which may not eventuate this year.

The effect of the loss of depreciation claims on businesses is also uncertain. This will have a direct cash flow effect on businesses, whether as landlords or tenants, particularly as a significant number of small businesses also own their own premises.  Many landlords have structured their affairs in the knowledge of the cash flow advantage that a deprecation claim provided. It is difficult to restructure their affairs given property is not a liquid asset at a time when other property owners are facing the same problem. Their only choice may be an increase in rents. Although there has been a timing advantage that historic depreciation provided, the removal of the deprecation claim will have an immediate negative cash flow impact on businesses.

The government has also signalled a review of the border between the building structure and what qualifies as fit out, which will inevitably lead to further denial of depreciation. To top off the bad news on this front, the government has removed the incentive to invest in business structure through the removal of the 20% loading of plant and equipment.

The final piece of the uncertain puzzle is the effect of the broad ranging personal tax cuts on business. Historically there has been an increase in consumer spending when personal tax cuts occur. However, the message given by the government is that such cuts are designed to offset the impact of GST and encourage individuals to save or reduce their personal debt levels. With interest rates projected to rise in the immediate future, it is likely the personal tax cuts will have a limited direct effect on buying behaviour and thus not result in a beneficial increase in consumer demand for businesses.

The government has stated the budget is about rebalancing the tax system for growth.  That means less immediate benefits for businesses and more changes about how businesses are taxed; reducing the headline corporate tax rate, removing an incentive for investment in property and reducing the competitive advantage foreign-owned businesses have investing in New Zealand. All that is needed is a positive turn in the economic fortunes of the country to take advantage of these changes.

Further enquiries, please contact:

Greg Thompson

National Director, Tax

D +64 (0)4 495 3775

E greg.thompson@nz.gt.com