Much Ado About Nothing
The Herald journalist who produced yesterday’s spam continues his story about nothing today. Now he has a nice long rant from Ian Powell of the Association of Salaried Medical Specialists (senior doctor’s union). Not that Ian has bother to check his facts either.
“Despite a doubling in government spending on health in the past 10 years, Mr Powell said public hospitals were under-funded. “While hospital costs have increased by around 6 per cent per year, funding has increased by around 3 per cent.”
“Ten per cent cuts on top of this “will risk compromising patient access to public hospitals, the quality of care, and patient safety.””
Strange how he doesn’t seem to realise that the increase in funding was nearly 7% last year (and most of that went to hospitals). He has also not bothered to check the hospital’s exaggeration against Tony Ryall’s actual words, choosing just to pontificate on the proposed 10% cuts – despite this being patently absurd.
Ryall has proposed no overall cuts at all. He has sensibly signaled that the DHBs should shut down some of their health promotions, especially in schools, and move the money into more vital areas such as cancer treatment. While no one denies that health promotion is important, the simple fact remains that in the current economic climate the health services in this country need to prioritize their spending. Health promotion has a notoriously low bang for the buck, mainly because so few of them make any appreciable inroads into the health problem they are addressing. It is far more important that the DHBs get their elective services right, before they start spending money on health promotions with dubious results.
Later in the piece Ian Powell talks about his real concerns though – doctor’s salaries. As the doctor’s union rep, this is a perfectly legitimate concern and , ironically, about the only valid one. With budgets being squeezed everywhere (not just in health) there is precious little room for DHBs to address the uncompetitive nature of doctor’s employment packages, making it difficult for them to recruit and retain doctors. The gradual doctor brain-drain looks set to continue.
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Nov 21 09 9:30 am
While no one denies that health promotion is important
Excuse me, but I deny that health promotion by the state is important
Wanting such a thing is tantamount to wanting an nanny state, and I challenge you to find a biblical justification for state health and the related taxation. If you cannot find such a justification then the taxation is immoral and illegitimate.
If privately funded organisations want to promote health I have no problem with that.
Kiwi Polemicist´s last blog ..• Right to silence under threat
Nov 21 09 10:13 am
We have been terribly short of resources for the last 6 or 7 years. We have been given the go ahead to increase them – but will only make up to about what we needed 4 years or so ago…….but we are still being drowned in paperwork and reviews, etc, dreamed up by bureaucrats. The number of non medical staff is quite something to behold!
With regard to salaries, as a senior clinician at the top of the scale I get a reasonable salary (but do put in a lot of after-hour work to get it), however I’m amazed that newly qualified specialists can move to Oz and get at least double my basic pakage (in Oz$)at ground level entry. Powell has a point!
Nov 21 09 2:12 pm
KP
Given the absence of biblical references to the internet, isn’t it illegitimate for you to be blogging?
If not, why?
Nov 21 09 4:18 pm
bobux:
You’re obviously taking the mick, but here’s a serious answer for you.
If the state is going to violate everyone’s property rights by taking money at gunpoint* it needs a biblical justification for doing so. Similarly, if you are going to violate someone’s personal rights (kill or injure them) you need a biblical justification for doing so, eg self defence.
The only biblically justifiable state activities/reasons for taxation are rewarding of good and punishment of evil.
When I am blogging there is no violation of the non-aggression axiom so there are no parallels between that and taxation, injury or killing. You and I do not need a biblical justification for a morally neutral activity.
* I say ‘gunpoint’ because the state will use lethal force if you provide sufficient resistance to its demands for taxes.
Kiwi Polemicist´s last blog ..• Right to silence under threat
Nov 22 09 3:32 pm
if the brain drain is so bad why are doctor numbers increasing at 3 times the rate of the general pop?
Nov 22 09 4:22 pm
Thrills:
Do you have any reference to substantiate this extraordinary figure? I find it very hard to believe and I smell statistical bullshit. Between 1999 and 2007 there was a 13.2% increase in doctor numbers – substantially less than the 17% increase in population. Helen Clark tried to use the bald figure of 1141 new doctors in her debate with John Key which I have put paid to in this post.
Nov 22 09 6:36 pm
MCNZ latest stat report.
Show me the stat where one senior doctor is leaving every week.
Nov 22 09 6:45 pm
gp increase last measured year 7.5
specialist increase 10.5
And you would expect these figures to be high as the government and the DHBs attempt to address the doctor shortage.
Nov 22 09 7:24 pm
Thrills:
The 2008 stats show a 2.4% increase in the overall number of doctor. Nearly all of that increase is in imported doctors as New Zealand consistently fails to retain New Zealand grads or even seasoned foreign doctors who are familiar with the NZ system. Doctors per head of population remains fairly static at 303/100,000 (barely up from last years 299/100,000) which suggests to me that the overall increase is being eroded by doctors working fewer hours (hence the low FTE rise).
I also note that House officers are still not back to the 1999 level – which was still considered to be inadequate in 1999!
It also appears that it is the foreign graduates who are the ones leaving. The two year retention rate seem less than 50%. Once again that emphasises the need for a more home-grown solution for our doctor shortage.
Nov 22 09 7:28 pm
I thought Ian Powell represented senior doctors? Last year the groth was more than 3 times the general pop!
p.s. NHS doesn’t want our juniors
neither does OZ
Ryall knows this
also, explain the one doctor leaving a week bit!
Nov 22 09 7:31 pm
amusing asms never mentions the official stats!!!
Nov 22 09 8:45 pm
Thrills:
It is not very likely that you will see me defending Ian Powell! And I am a GP in private practice and have no vested interest in senior doctor’s working conditions. I have no idea where Powell gets his one doctor a week statistic from, but I do know that the medical council used to keep those stats, but they do not appear in the annual report any more. In the past two years I have seen four of my circle of GP and specialist colleagues move to Australia, including one last week. It is not a stretch for me to believe that statistic (and, presumably, Powell has some basis for it)
Regardless of how we churn our statistics, we still have a serious shortage of junior doctors and relative shortages of GPs in rural areas. These problems need to be addressed.
Nov 22 09 9:12 pm
OK, so we have one leaving a week and one entering per day. Movement from 299 to 303 is significant- failure to appreciate it indicates ignorance of math.
One thing you should understand: if the government pays for it (if it’s free) there is always going to be a doctor shortage. If people had to pay their own way at the current rates we would have a massive surplus of doctors.
It just seems funny to me that the senior doctors are such poor communicators of basic statistics. the stats don’t back up their misguided viewpoint.
Nov 22 09 10:24 pm
299 to 303 may look like a move in the right direction, but has to be interpreted in the light not only (as MacDoctor has pointed out), of less hours on average worked per doctor, but also of greater demands from an aging population. The eighty-plus age group makes by far the greatest per capita demand on doctors in almost all specialities, and it is a group that is increasing at much faster than the population as a whole.
Good point about the oldest old. They can be very demanding of resources, including doctors
Nov 22 09 10:42 pm
Another related issue: aging of the medical workforce.
The Medical Council has published statistics on this, and from memory it is particularly pronounced in General Practice and Pathology: An alarmingly high proportion of doctors in these specialities are in their fifties and sixties, far fewer in their thirties.
While some of us believe ourselves immortal, and intend to carry on working forever, this may not be realistic!
Emigration is particulary high among young doctors, and not surprisingly. New Zealand is a small country, and many newly qualified doctors (correctly in my opinion) see it as essential to round off their education by working in bigger centres which offer more varied experience and the stimulation of exposure to different ways of doing things.
Most probably go on their OEs with the intention of coming back, but many are seduced by what they find.
The challenge is to make New Zealand a more attractive workplace, and that is not purely a matter of money. The crushing bureaucracy of the publicly funded health sector in New Zealand plays a not unimportant role in scaring young doctors off.
I totally agree that there is more to an attractive workplace than money. However, money helps a lot!
Nov 22 09 10:58 pm
Thrills: Movement from 299 to 303 is significant- failure to appreciate it indicates ignorance of math.
I suspect it is you who are struggling with the maths. The extra 4 doctors per 100,000 represents 168 doctors (in a population of 4.2 million) which means there are 138 extra doctors that have disappeared into the system. Almost certainly, this is due to doctors who have reduced hours.
One thing you should understand: if the government pays for it (if it’s free) there is always going to be a doctor shortage. If people had to pay their own way at the current rates we would have a massive surplus of doctors.
I understand the principle of moral hazard very well, but I don’t see it applying in this case. If pricing controlled doctor numbers, why would the US have a significantly higher doctor to patient ratio than New Zealand?
Nov 23 09 7:42 am
wrong about the 138 already disappearing. They are maintaining the basic 299 against the general pop growth!
one leaving a week, one joining a day. crisis.
some incidentals: the NHS doesn’t want our doctors and Australian Medical school deans are lobbying to reduce the number being trained. Do you think they need ours? Where will the doctors who wanted to go to Australia or Britain want to go?