Cold Periphery
One of the signs of shock in a patient is cold peripheries – cold arms and legs due to lack of blood in them. The circulation always goes first at the outer edges. Once again the small peripheral hospital, Waitakere, is having to close off some services because it cannot fully staff them. Previously, it had to close it’s emergency department after 6.30 pm, because it had no doctors. Now the general medicine service is so scanty, that they are having to send the sicker patients to North Shore, because it is too dangerous to keep them. General medicine has therefore just downgraded to a rehabilitation and recuperation service.
I have already pointed out in another post that the Whitecross A&M down the road manages to stay open for 24 hours. So why does the public hospital need to close it’s emergency department? Clearly the only difference between the two is pay scales. Whitecross is offering nearly 3 times the amount for night work. That is the only difference.
Tony Ryall blames the previous government and says he is implementing ”medium to long-term solutions”. This is fine as far as it goes but the problem is right now, and the only solution is to put more money on the table. Funding urgently needs to be moved from non-productive areas of health (recent extra government subsidizing of GP visits come immediately to mind) and placed directly into hospital doctor’s salaries. In addition, Ryall needs to declare some areas in need of emergency staffing supplements and immediately boost funds available directly for places like Waitakere. They could then compete on the locum market and staff the ED after hours. Attractive salary packages would also lure overseas doctors here to fill in the service gaps.
I am not normally in favour of throwing money at a problem, but, in this case, there is little else that will work in the short term. Attractive salary packages for hard-to-staff areas would go a long way to temporarily filling the gaps in the services. Offering $200,000 plus a car and a relocation allowance would find most locum doctors showing some interest.
And for those who think that that is an obscene amount of money, that is exactly the sort of package offered to doctors in Australia (the outback packages are substantially higher than that). Medicine is a competitive field. We will continue to bleed doctors to Australia until there is some reasonable parity in pay scales.
Emergency services at Waitakere are essential services. It is nothing short of criminal to close them. The cost of accessing the Henderson A&M after hours is considerable ($95 for a medical consult, from memory). This means that low-income groups are seriously disadvantaged by lack of access to emergency services. I find that extremely unacceptable, especially considering all it will take is a relatively small amount of money to fix.
Mr. Ryall, stop mumbling about long-term solutions and fix this problem now.
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Apr 14 09 4:14 pm
Funny thing is that Australian papers are filled with similiar horror stories daily.
I see the RDA was suggesting more part-time flexible working arrangements. As it is most doctors work fewer than 40 hours a week now. I don’t see how cutting hours and paying more is going to lift productivity, which is the staed aim of the National Government. Let the consumers pay $95 at Henderson A&M.
Also, isoltaed “sweetheart” deals end in tears. Look at South Australia. The doctors all handed in their resignations knowing all too well the government would have to fold.
User pays is the way to go. People might be a bit more wise about seeking help if they were paying themselves.
Apr 15 09 1:04 am
Gammon’s Law:
Funny thing is that Australian papers are filled with similiar horror stories daily.
True. But the reason for that is that Australia makes it far more difficult to employ foreign doctors. Same result. DIfferent cause.
most doctors work fewer than 40 hours a week now
ROTFLMOA! Less than 40 hours a week – Don’t I wish!
Also, isolated “sweetheart” deals end in tears
Not really. Most evolve into amicable permanent arrangement. South Australia’s problems were more of a union action, than a sweetheart deal going sour. At least, that’s my interpretation.
Apr 15 09 12:37 pm
Hi Macdoctor,
I suppose my confusion is how is a country in the bottom third per captia gdp supposed to offer the same salaries as the countires in the top third? How will this help us “close the gap”? Yeah, doctors might not go overseas but the people who earn money for the country will leave! How will we offer doctors parity with OZ then? And why give pay jumps to some of the most unproductive workers in NZ? Did you see the healthcare productivity study before the last election?
You should look into Gammon’s Law and Roemer’s Law and while you’re at it look at the Dartmouth atlas to see that maybe we don’t have too few doctors, they are just not working in the right fields/areas.
Any ideas how the healthcare reforms in Australia are going to pan out? What about the burgeoning graduate numbers there and in the UK? What about the Australia medicare net possibly being reduced from 80/20 to 50/50? Impact on private fees= impact on public salaries. What about medicare billing rights being extended to nurses?
i think when the situation is so fluid it is ridiculous to say it is all unsolvable and the only answer is to pay more money than we can afford. But then again I’m not a medical doctor working at the “coalface” or whatever it’s called these days.
Apr 15 09 1:16 pm
Gammon’s Back:
Gammon’s Law: In a bureaucratic system, increase in expenditure will be matched by fall in production.
This is true, but not especially relevant to the doctor shortage unless you are suggesting that there is not a shortage of doctors. This would imply that all of the doctors we have are not being productive enough and the solution is to have us all working harder. This is complete nonsense.
All Gammon’s Law is really saying is that a bureaucratic system will eat up extra funding by expanding the bureaucracy, rather than the health service, thus hindering doctors and decreasing productivity.
Roemer’s Law: in an insured population, a hospital bed built is a bed filled
Again, Roemer’s law does not tell us anything about doctor shortages. It does not even tell us much about hospital beds. What it does do is restate the law of moral hazard. Because (in an insured or government funded system) the cost of the hospital bed is apparently nil, it will be filled. Moral hazard simply states that use of a service is maximal when the perceived cost is zero.
Quoting these laws suggests to me that you seem to think the problem is one of productivity, but it is actually one of access. The Dartmouth atlas neatly shows that doctors and health services in general tend to gravitate to the place where money is maximal. This is hardly surprising. All I am suggesting is that a temporary solution to the doctor shortage and the problem of access is targeted salary packages in hard to staff areas. Longer term, these will be solved by voluntary bonding and increasing the number of graduates plus movement towards some sort of pay parity with Australia.
Note that it is Australia’s own shortage of doctors that is exacerbating our situation. If Australia did not need doctors, we would not need parity.
Let me emphasise that doctor’s salaries are a relatively small burden on the health system and near-parity could easily be achieved by simply moving health dollars from other, less useful areas. The DHB reaction is usually to move money from elective surgery, exactly the WORSE place (my, how I love bureaucrats!)
Australia’s problems are, frankly, Australia’s problems. The only way they could effect New Zealand is if they restricted the movement of NZ doctors to Australia. This will not be happening in the near future, which is the time frame we are currently talking about.
Apr 15 09 3:23 pm
Hi MD! Thanks for the reply.
Yeah, I reckon we have enough doctors. But if unions don’t want to engage in reasonable workforce planning to ease pressures here is what I’d do.
Open another couple of medical schools- those four year graduate degrees like abroad. Crank out the doctors. Provide training slots in areas of shortage. Don’t rely that graduates preferred specialties will create a balanced workforce! More doctors would weaken the strength of the unions, as it has done in Ireland/England. As would a pool of nurse practitioners….
I’m sure you’re aware that they are looking for efficiencies in the Australian system (Garling report etc). If we want to be like them shouldn’t we being doing the same? It’s not about working harder, it’s about working smarter.
Having said that I do think we should be spending just as much a percentage of our GDP on doctor salaries as the Aussies do. But no more.