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96 posts

Master Geek
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Topic # 97925 22-Feb-2012 03:57 Send private message

Having recently been given a 3 week wait for an appointment to see a Doctor in Foxton and having been treated in the last 18 months only by Locums, I requested the retired Doctor Locum suggest a "new Doctor" for me.
I was then informed that this Doctors last practice in Levin had thousands of patients trying for the
same thing ... a regular Doctor.
The retired Doctor then told me that New Zealand was becoming a Nation of "Hobby Doctors", with Women Doctors
now dictating the hours they will work, part time, as they juggle the family, pregnancy and the life style farm.
The Women Doctors are not prepared to work 70 hours per week as was the "norm" for the Family GP.
They have become selective not only of the hours they work, but of the patients they see.
I was astounded to hear this regarding Women Doctors and wonder if there are any views on this?

Regards Tedz


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819 posts

Ultimate Geek
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  Reply # 584916 22-Feb-2012 04:31 Send private message

Can't comment on the plight of doctors but after reading your post this it made me realise this ideology is systemic within the employment sector itself. In my job it was 40hr or nothing when I first started. They then introduced part time night work for students studying. They now have a team that work mornings only to cater for mothers who can get home before children finish school. And now they are trialling working from home.

Lives appear more important than work. There is no panacea that will appease everyone.

616 posts

Ultimate Geek
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  Reply # 584937 22-Feb-2012 08:14 Send private message

Again not really about the doctors (I feel your pain - we often have to wait 2-3 days for an appointment in Wellington sometimes) but what you've described is not surprising.

Im a big supporter of work/life balance. Ive worked at a "values based" company before where this balance was pushed hard and I follow that philosophy in all my jobs since then.

However I wonder how long it can last? NZ might be isolated but when you look at the "hollowing out" of the middle income class in the USA I dont think people in NZ can do this forever. A time will come when it will be easier to just get someone else to do the job than pander to people on a whim.

This article scares the crap out of me;       

http://www.nytimes.com/2012/01/22/business/apple-america-and-a-squeezed-middle-class.html
  
We may also be somewhat protected from this due to strict immigration policy but people shouldnt take all this work/life balance stuff too far or they may be in for a shock... 

984 posts

Ultimate Geek
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  Reply # 584977 22-Feb-2012 09:37 Send private message

Primary health in the form of the GP is an interesting beast. Its a practice that a lot of people do not understand requires massive amounts of training, equating to highly skilled workers. It is also a very protective area, with attempts by DHBs to reduce pressure / other productive ideas being shot down by GP's as encroaching on their territory - take the Warfarin and INR testing by pharmacists as an example.

Personally I think when you have a highly skilled job, with multiple employers but few potential employees you can dictate terms that suit you. Is there an element of truth to what your GP told you? Probably, but it would seem he has made a gross generalization. Dont forget he is being paid 50% more or upward to be a locum that most likely the DHB fund the difference, everyone works the system for their benefit!

847 posts

Ultimate Geek
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  Reply # 584989 22-Feb-2012 09:53 Send private message

Few comments:

The Warfarin INR thing is an issue, because of already sunk costs. The paper from AUT suggesting this would be a good idea ignored the fact that patients pay GPs for this at the moment, and that the DHB covers the cost of the test in a Community Labs contract. A DHB would probably be happy for a pharmacy to do this, they just don't want to pay extra for something they are already paying for.

Ability to get a Drs appointment - we hear your pain (generally worse in the UK as the GP visit is free). We are working on building an phone/online facility in Wellington/Porirua/Kapiti which shows appointment availabilty across all the GP practices (ie. there may not be an appointment at your practice, but there might be one down the road). We are also working on the process by which people get appointments, often the decision to give someone a same day appointment is made by a receptionist (which could probably be improved). However this is slow as all are individual small businesses.

Granted there has historically been a significant role for GPs in Primary Care, however we are seeing that move to much more of a team approach with nurses and other staff taking on much broader roles. We are notoriously poor in healthcare at communicating our expectations of service delivery for the public, and often have these expectations created as political tools (eg. Health Targets).

Hope this helps,

Jon


2609 posts

Uber Geek
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  Reply # 584997 22-Feb-2012 10:01 Send private message

Is the "retired doctor" Dr. Mole? 

My M-in-L stopped going to him years ago because he was a bit of a dinosaur...and the things you report are consistent with his views on women.....

Female doctors do want to have families. They do tend to group together in practices (like Raumati Medical Centre) so they can support / cover each other. That just makes sense and the patients are better served over all.

Dr. Mole's 'sole practitioner' model is not the best....and it is being discouraged from every angle. Those 70-hour weeks you refer to a big part of the reason for that. Tired people make mistakes.

I went to Dr. Nagoor for a while....but Foxton could use more doctors. I think the doctor who got murdered there by some druggies put many doctors off for a long time.  




____________________________________________________
If you're not curious, your brain is already dying...if not dead.





96 posts

Master Geek
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  Reply # 585007 22-Feb-2012 10:15 Send private message

@ Linuxluver ... the retired Doctor was not Dr.Mole.

I don't believe it was an anti Woman remark, just how it is.
Similar was my waiting 3 weeks for a dental appointment, thinking this was due to the Christmas holidays I was happy to wait. However my dentist now told me that she only works part time and that was the reason for my wait.
She now is content to pull out stumps on the farm ratrher than teeth in the chair *grin*

1046 posts

Uber Geek
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  Reply # 585074 22-Feb-2012 11:33 Send private message

Having just moved to Paraparaumu we were amazed at how many of the local doctors A: Were not accepting patients and B: Are greedy bastards. Only one single provider on the coast has enrolled patient fees under $20.

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Ultimate Geek
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  Reply # 585077 22-Feb-2012 11:45

I find this discussion a bit offensive - GPs wishing to work fewer hours is absolutely not restricted to female doctors only.  

The biggest change, however, has been the after-hours component.  Rather than the old-fashioned system where you had a single GP, who was available 24/7 for his patients, almost all GPs have amalgamated into group practices where there is more than one physician operating at the same practice.  Moreover, most (if not all) GPs are affilliated with an after-hours urgent care facility - hence rather than being on call 24/7 (or even, say 1 in 3 for a three-doctor group practice), you might find upwards of 60 GPs working for a single after-hours urgent care facility, effectively being on-call once a month or two.

Wanting better work/life balance is not a crime, and a more efficient on-call structure in the form of after-hours urgent care has enabled this.  It is not restricted to female doctors only, and it is highly disingenuous to blame this for the difficulty in obtaining a regular GP - remember, standard hours (during which you see your regular patients) have not changed significantly.  

The issue is not one of "hobby doctors", it is an issue of not having enough doctors to cover an ever-increasing workload (a gross over-simplification, but closer to the point).

(I am not a GP, but I am a doctor) 

654 posts

Ultimate Geek
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  Reply # 585101 22-Feb-2012 12:02

Lias: Having just moved to Paraparaumu we were amazed at how many of the local doctors A: Were not accepting patients and B: Are greedy bastards. Only one single provider on the coast has enrolled patient fees under $20.


The fees set are probably most likely determined by the level of funding the GP and/or their PHO receives from the local DHB.  Some PHOs that serve lower socioeconomic regions are allocated a greater amount of funding, allowing for lower end-user fees (although this doesn't stop people travelling from out-of-zone to take advantage of the cheaper fees).  

GP fees are fairly tightly controlled and under fairly close scrutiny (http://www.nzdoctor.co.nz/media/445508/annual_statement_final_march_2011%201%20.pdf) - unlike other industries, it is not set by the market but largely determined by the balance of government funding and operational costs.  Calling it greedy?  Please.

 

114 posts

Master Geek


  Reply # 585155 22-Feb-2012 13:40 Send private message

i live in Timaru. Typically I can call up my doctor 8:30am, and be in by 10am that morning.



96 posts

Master Geek
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  Reply # 585166 22-Feb-2012 14:03 Send private message

Dear KevinL ...
I am sorry that you find this discussion a bit offensive and the term "hobby doctors" may very well not be the correct terminology. How about I class myself as a "hobby patient" or just a grumpy old man?
However it does not change the fact that not only have I had to wait such a long time for appointments with
no regular Doctor, I am also, along with other Patients waiting up to 3 weeks for a Doctors signature on a repeat prescription, but I am not in a position to be offended, I am in the position of take it or leave it.

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Ultimate Geek
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  Reply # 585169 22-Feb-2012 14:12

tedzart: Dear KevinL ...
I am sorry that you find this discussion a bit offensive and the term "hobby doctors" may very well not be the correct terminology. How about I class myself as a "hobby patient" or just a grumpy old man?
However it does not change the fact that not only have I had to wait such a long time for appointments with
no regular Doctor, I am also, along with other Patients waiting up to 3 weeks for a Doctors signature on a repeat prescription, but I am not in a position to be offended, I am in the position of take it or leave it.


My point is that the problems you are experiencing have very little to do with the reduced hours that doctors are working - if anything, their regular hours have increased over the past decade or two (while their after-hours time has reduced significantly).  The issue is more that there aren't enough GPs to cover the workload, especially in rural areas.  Seeing a locum GP frequently doesn't suggest that the other doctors are working fewer hours, it suggests there is a vacancy that hasn't been filled (or the doctor they are relieving for is on leave).

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Uber Geek
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  Reply # 585172 22-Feb-2012 14:18 Send private message

KevinL:

The fees set are probably most likely determined by the level of funding the GP and/or their PHO receives from the local DHB.  Some PHOs that serve lower socioeconomic regions are allocated a greater amount of funding, allowing for lower end-user fees (although this doesn't stop people travelling from out-of-zone to take advantage of the cheaper fees).  

GP fees are fairly tightly controlled and under fairly close scrutiny (http://www.nzdoctor.co.nz/media/445508/annual_statement_final_march_2011%201%20.pdf) - unlike other industries, it is not set by the market but largely determined by the balance of government funding and operational costs.  Calling it greedy?  Please.

 


Same PHO, same DHB, same smallish geographical area. One provider charges $15 for an adult consulation, Others centres in the same geographic area charge $38, $39, $40, $41, $44, $47, $48, $55, $62.

I'm guessing they've all refused to go on a VLCA scheme, which as far as I can tell means they want to make more profit, and that is pretty much the textbook definition of greedy.

I'd genuinely like to hear a doctors comments on that though, it's not exactly easy for us at the consumer end to know what's going on with PHO's etc.




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  Reply # 585175 22-Feb-2012 14:25 Send private message

KevinL: 
My point is that the problems you are experiencing have very little to do with the reduced hours that doctors are working - if anything, their regular hours have increased over the past decade or two (while their after-hours time has reduced significantly).  The issue is more that there aren't enough GPs to cover the workload, especially in rural areas.  Seeing a locum GP frequently doesn't suggest that the other doctors are working fewer hours, it suggests there is a vacancy that hasn't been filled (or the doctor they are relieving for is on leave).


I agree completely with what you said, also I think people seem to be going to the doctor for minor illnesses, cold, or flu, which could easily be treated over the counter.  Or a slight strain.

I used to have a great doctor, who was working 40-60 hours a week, but the time took it's toll.  She was also working on Friday/Saturdays at a short staffed A&E. 

Working those long hours, just isn't right.  And I think she was right to change her mind, and change careers.  I know I would if I was forced into longer than needed hours, for no reward.

 




I have moved across the ditch.  Now residing in Melbourne as a VOIP/Video Technical Trainer/Engineer. 

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  Reply # 585179 22-Feb-2012 14:32 Send private message

tedzart: Having recently been given a 3 week wait for an appointment to see a Doctor in Foxton and having been treated in the last 18 months only by Locums, I requested the retired Doctor Locum suggest a "new Doctor" for me.


Just wondering if it could be:

- The aging population, average age is 42+, compared with 35 nationally
- Socio-economically deprived area
- Median incomes are likely to be 25-30% lower, meaning more illness is likely
- High risk of injury, as most of the community is involved in agriculture, manufacture, forestry or fishing 
- High rate of teen pregnancy


Meaning: injuries, sickness, pregnancy related appointments would be skyrocketing.  Especially among the aging population(for sickness/injuries, not the pregnancy part)




I have moved across the ditch.  Now residing in Melbourne as a VOIP/Video Technical Trainer/Engineer. 

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