Folding the Deck Chairs

Waitemata, Auckland and Counties Manukau District Health Boards are complaining that they can’t recruit sufficient numbers of junior doctors to fill all available positions. Their solution is unique – they want to reduce the jobs by up to 20 per cent and rely on senior doctors and senior nurses to fill the gaps.

It’s a miracle these people manage to drive their cars to work each morning, let alone run a health service.

Disestablishing the junior doctor’s positions is the equivalent of shutting down an Airbus 320 engine because you forgot to fill the wing fuel tank – and then ignoring it because you have lots of fuel in the other wing’s tank. It is enormously dangerous and almost certainly doomed to failure. It is highly likely that people will die. It runs completely counter to all common sense.

The DHB rationale for this runs apparently thus:

“In a statement from the three DHBs, Counties Manukau chief medical officer Dr Don Mackie said workforce numbers would not change because senior nurses, doctors and locums were already filling the gaps.

““We want to make sure the paperwork matches the reality,” he said.”

Translation: We are hanging on by a thin thread that will break any minute, so we’d like to make the paperwork tidy.

This is a mind-bogglingly stupid thing to do. It reads like something from Hitchhiker’s Guide to the Galaxy. It is not even rearranging the deck chairs on the Titanic, it is folding them up and putting them away.

Surely even the densest of board members realise that senior doctors are covering the gaps because they are under the impression this is temporary and they want the service to keep going? As soon as they understand that this is not only permanent but likely to get worse, they will be across the Tasman – where they will have junior doctors to help with the work-load – faster than you can say “Waltzing Matilda”. Offering them nurse practitioners (eventually) is unlikely to impress any of the senior doctors. There is good evidence that nurse practitioners can handle about 80% of emergency department work, but this percentage drops dramatically in specialist units in hospitals. They are certainly NOT the answer to the junior doctor shortage, even in EDs.

Dr Deborah Powell, the general secretary of the Resident Doctors Association, is correct when she observes:

“…the problem wasn’t a lack of residents to fill the jobs, there were 400 doctors working as locums in Auckland. The problem was that none of them wanted to work as residents because of the pay and conditions the hospitals offered. 

““They just can’t retain people … that’s their fundamental problem. They are bad employers. We [residents] start on $25 an hour. As a locum we will earn at least four times that.”

I know she is right. Waitakere hospital’s emergency department now closes at 6.30pm because of staff shortages, but the Whitecross A&M at Henderson stays open all night. Guess which one pays the most.

Money, of course, is not the only issue here, but it features large. Junior doctors have student loans averaging $65,000. 10% of the owe more than $100,000. Yet they are being offered $25 per hour on average. Small wonder that they become locums or disappear across the ditch. 

The most worrying aspect of this is the apparent lack of concern of Tony Ryall, who dismisses this as another “operational issue”. This is not something that he can ignore. National campaigned on the issue of increasing the number of doctors and nurses in the staff-anaemic health system. He cannot allow the Auckland DHB’s to undermine the initiative by saying “we don’t need any extra doctors anymore – we just closed all our services instead”. At the very least, the MoH needs to be checking on the quality and sustainability of the services from which the junior doctor’s positions are being removed. After all, We are paying for the health service, regardless only any mythological “independence” that the DHB may have.

Cunliffe removed an entire board just for squabbling. Surely, Ryall can discipline them for allowing bureaucracy to destroy health services? After all, destroying health services with paperwork is the province if the Ministry of Health, isn’t it?

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