AUGUST 10 2019 LISTENER 25
43% of GPs are 55 or over
and 47% intend to retire
in the next 10 years.
55% are women,
increasing to 65%
among those 55-plus.
Only 4% of GPs identify
as Māori, increasing to
8.5% among those under- Pacific people make
up only 2% of GPs. The
percentage identifying
as Asian is 18%.
39% of GPs were trained
overseas, rising to 46%
among rural doctors.
75% of GPs work in
urban settings.
GPs work 34.8 hours a
week on average (men
38.9, women 31.6).
26% of GPs rated
themselves high on the
burnout scale, a figure
that has steadily increased.
Doctors reporting
burnout were significantly
more likely to be aged
between 50 and 64.
31% of GPs reported their
practice had a vacancy
for at least one doctor,
up from 26% the year
before. In rural practices,
39% had a vacancy.
11% of GPs said their
practice wasn’t accepting
new enrolments.
The average GP income
was $156,000; the
median was between
$100,000 and $125,000.
Source: RNZCGP 2018 General Practice
Workforce Survey
plans to talk to the Treasury and the Min-
istry of Health to discuss its model further.
Tom Love says some practices are trying
to cull their enrolments because they can’t
cope with the numbers as patient needs
become more complex. A decade or so ago,
those practices were working sustainably, he
says. A survey by the Royal New Zealand
College of General Practitioners (RNZCGP)
in 2017 found nearly 40% of practices in
Tairāwhiti, on the East Coast, aren’t taking
enrolments, followed by 32% in South Can-
terbury, 31% in Hawke’s Bay and Taranaki
and 24% in Whanganui.
Whanganui, however, is something of
a success story when it comes to attract-
ing new doctors, thanks to an initiative
launched in the early 2000s that allows GPs
to work for salaries rather than having tocommit to buying their own practice.
“We’d lost about a third of the GPs we
needed, through retirement and people
moving away and being unable to replace
them, says John McMenamin, a GP who’s
practised in the area for nearly 40 years. It
had left Whanganui with only 22 of the 33
GPs it needed. McMenamin, who supervises
GPs in training, says the inability to retain
them led to a group of independent GPs
establishing a day-service at an after-hours
clinic in Whanganui, staffed by two of the
registrars trained the year before and sup-
ported by locums. It allowed the doctors to
stay on in a supported environment with-
out investing financially in a future there.
The clinic was so successful it spun off
other services, including an accident and
medical clinic in the grounds of Whanganui
Hospital where patients with minor injuries
or low-level medical problems are triaged
and sent to the hospital only if they need
more intensive care. McMenamin says the
DHB is committed to equitable health
services, and an iwi-led practice, Te Oran-
ganui, in the central city and Waverley, is
also helping to meet Māori health needs.
Understaffed and under-resourced“We’d lost about a third
of the GPs we needed,
through retirement
and people moving
away and being unable
to replace them.”less-affluent areas where there could
be a cultural disconnect between them
and the communities they serve, says
Lawrenson. “We are doing a lot of work
with Māori communities who say they
have difficulty trusting doctors who
don’t understand their culture.”
Māori GP Marty Mikaere, who works
in Thames with rural iwi-based provider
Te Korowai Hauora o Hauraki, agrees.
Mikaere, a GP for three years, spent six
years in emergency nursing in the US
before training as a doctor. The Hauraki
clinics (in Thames, Te Aroha, Paeroa
and Coromandel) had had a revolving
door of overseas-trained locums, which
meant people sometimes didn’t get
continuity of care.
“There is a cultural divide,” says
Mikaere. “If you’re used to working
with Māori people, you don’t get put
off when they want to bring their
whānau in with them, but some people
might get intimidated by it. If you can’t
develop a good rapport with the person
sitting in front of you, you’re likely to
get 30-40% less information and you
don’t get the stuff they’re more embar-
rassed about because they don’t trust
you enough to bring it up.”
He runs two-hour walk-in clinics in
the mornings and afternoons during
which patients are seen first by a nurse,
then, if necessary, by him. “They’re my
people and I can relate to them,” says
Mikaere, who’s from Coromandel and
intends to stay in the region long term.
“Trust makes it easier for me to do the
job.”
He describes general practice as the
“red-headed stepchild of medicine
whom everyone looks down on and
abuses a little bit. What they don’t
understand is general medicine isn’t
filled with snotty noses and mundane
things. Today, I’ve seen two people with
suspected bowel cancer, a guy we’re
having to chase down who has mental-
health issues, a family with
bronchitis and a litany
of other tough things.
When I started in
general practice, I
thought I’d managed
to find this secret
thing that nobody
understood, like, how
good the job is.”
General
practice – by
the numbers
Population health professor Ross Lawrenson.