|Medicine and Beyond #26: Finding our Voice|
|Written by scrubs|
|Tuesday, 14 September 2010 16:09|
The significant issue of NZ’s doctor shortage is certainly not new, but it has recently achieved a reasonable level of media coverage. In particular, I watched with interest the short Sunday evening documentary that examined NZ’s ongoing recruitment and retention issues.
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.