Hobby Doctors in the Horowhenua

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NZtechfreak

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#585180 22-Feb-2012 14:32

Glad you made a substantial reply Kevin, saved me the effort.

Echo your thoughts, and I am a GP.

As you say Kevin wanting a better work/life balance is not confined to women in our medical workforce - case in point I only work Tuesday-Friday (and the occasional Saturday morning here and there). Wanting to be there as a father for my nearly two year old son is a major factor in my current working arrangement. I'm passionate about my work and very dedicated, so I'm fairly disappointed to learn that I'm a "hobby" doctor - or does that only apply to female doctors who think family is important?

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KevinL

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#585185 22-Feb-2012 14:40

Lias:

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.

Maybe there is a GP on the boards who can comment. My vague understanding is that eligibility for the VLCA payment is fairly strict (50% high needs population, defined as Maori, Pacific, or New Zealand Deprivation Index quintile 5) and these practices also rely on a further DHB/PHO top-up to cover their costs (e.g. http://www.stuff.co.nz/dominion-post/news/5067876/Low-cost-clinics-in-line-to-lift-GP-fees). The other point is that the consultation fees are regulated at a DHB level - if a practice wishes to charge higher than a set "reasonable" amount, it has to go through an approval process.

GP renumeration is a fine balance between attracting enough doctors into the area/profession, and maintaining reasonable consultation fees (mind you, I don't believe that GP renumeration is that big of a slice of the pie - I'd wager that other operational costs far exceed GP renumeration as the primary cost of running a practice). Doctors - and certainly not GPs who are probably amongst the lowest paid specialists - don't go into the profession for money (if they did, then they are idiots).

KevinL

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#585188 22-Feb-2012 14:45

Some interesting trends from the most recent RNZCGP survey (2008):

• The mean and median age of GPs continues to increase as the GP workforce ages.
• GPs spent a greater percentage of their time consulting with patients in 2008 than they did in 2005
• GPs are spending a lower percentage of their time on on-call duties (after-hours care).
• The average hours worked per week by GPs has decreased from 48 in 2005 to 42 in 2008; male GPs reduced their average hours from 55 in 2005 to 49 in 2008, while female GPs reduced their average hours from 39 in 2005 to 34 in 2008.
• Nearly a fifth of GPs will retire within five years
• Although there is an increase in the recruitment of medical graduates into general practice in 2008–09, it may not be enough to replace the GPs who are likely to retire in the near future.
• The 46–55 age cohorts had the highest percentage of GPs working in rural areas and those intending to change their work arrangements in the next five years.
• Seventy-five percent of GPs in the 56–65 age cohorts were males; worked the longest hours; and the majority intend to retire in the next five years.
• GPs in the 66–71+ age cohorts preferred locum work and self-employment; the majority will retire in the next five years

tedzart

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#585190 22-Feb-2012 14:46

Dear NZtechfreak ...
I will apologize about the term that is upsetting you, that being "hobby doctor" and alleviate your disappointment.
However, as a patient with continuous medical problems, I am also disappointed with not being able to get appointments or my repeat prescriptions filled. I am not an educated man and do not mean to offend, but don't
be too upset about 'hobby doctor' that is too trifling to spoil the day *smile*
I still think Doctors are fine fellows regardless of their gender.
*salute*

jonherries

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#585196 22-Feb-2012 15:03

Lias:

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.

Interesting comments about price. We wonder often whether how sensitive people are to GP prices, as presumably if everyone was sensitive to this the cost of general practice would be more even, and lower.

[Insert large conversation about agency theory, therapeutic relationships, paternalism etc]

That being said, VLCA practices get additional funding for reducing prices (improving access). So maybe wipe the $15 practice off the list and look at the range for the others, $38-62.

Given they are small businesses, that provide a service, which has an implicit issue with a service's value ie. people value a more expensive service more highly, as there is a difficulty measuring the quality of the product.

The variance could be a product of the efficicency of the businesses.

tedzart

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#585207 22-Feb-2012 15:24

I will attempt to explain more, without upsetting anyone or upsetting all.
Horowhenua, especially Foxton and Levin have had a Doctor shortage for years and I believe it is demographically in the lower socio/economic zone. Rich man poor man pay the same fee, around $17.00 (Foxton)
but that is not the problem. The problem, from the patient (my) point of view, is there are not enough Doctors
for the area ... a Levin Doctor closed up shop recently due to bad health and these patients have been absorbed by other Doctors in the area and added to the workload of visiting Locums.
The Doctor I had last seen, who mentioned the "Women Doctors" with all due respect, also mentioned that in todays NZ, it is the girls who are excelling at school and going on to be Doctors. They are the ones putting in the 6 years of
Medical Training. They become excellent Doctors. They, like normal human beings go on to get married and have a
family. They return as Doctors, but often that is restricted due to family. I use the word "part time" not to insult, but to
point out that is exactly what it is, lets say two days a week for example. This is not putting Women Doctors or any Doctor down, it just leaves "Doctor Gaps" that are not being filled, creating a larger work load for the Doctors in the
main and more distress for patients that may become distressed by the workings of the PHO.

NZtechfreak

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#585259 22-Feb-2012 17:13

tedzart: Dear NZtechfreak ...
I will apologize about the term that is upsetting you, that being "hobby doctor" and alleviate your disappointment.
However, as a patient with continuous medical problems, I am also disappointed with not being able to get appointments or my repeat prescriptions filled. I am not an educated man and do not mean to offend, but don't
be too upset about 'hobby doctor' that is too trifling to spoil the day *smile*
I still think Doctors are fine fellows regardless of their gender.
*salute*

I'm not upset at all, can be hard to read tone in writing sometimes I guess - that was sarcasm!

I appreciate the difficulties for you as a patient being in an area with staffing challenges for health services, but that GP's analysis is so desperately shallow as to be laughable. Broadly misattributing the problem like that doesn't really help anyone find a way forward to addressing the multi-factorial nature of the problem.

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gzt

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#585294 22-Feb-2012 18:04

Did the voluntary bonding scheme have any effect in this area or was it a bit of a fail?

KevinL

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#585313 22-Feb-2012 19:01

gzt: Did the voluntary bonding scheme have any effect in this area or was it a bit of a fail?

I'm not sure the voluntary bonding scheme really worked in any area, except to reward the people who would have gone there (or into those particular specialties) anyway. Plus, in the case of general practice, you can qualify for the bonding scheme regardless of where you are working (as it is deemed as a specialty in need).

Some sort of universal bonding scheme probably would have been more useful - I don't think the root issue is staffing unpopular specialties/areas, I suspect the larger issue is the number of graduates who disappear to Australia where remuneration is somewhat better (significantly better as a specialist). Retaining more doctors overall leads to a flow-on effect to the harder-to-staff areas.

Unfortunately, government is horrifically short-sighted. At one point they were investigating shortening/compressing the medical school training to 5 years (rather than 6) as a solution to the junior doctor shortage - until someone pointed out that it would only yield them one additional cohort of students.

gzt

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#585373 22-Feb-2012 21:44

That's interesting.

Would I be correct in guessing that remuneration would be a significant attractor but drivers like vocational training and relatively minor dissatisfactions with the working environment are playing a large part in the junior feeling to move?

If so, then dedicating more resources to training activities and fine tuning the work environment could well be more effective in retention than increasing salaries alone.

Also it seems the locum ratio has tipped to the point where it is a long haul back no matter which solutions are employed.

KevinL

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#585376 22-Feb-2012 22:11

gzt: That's interesting.

Would I be correct in guessing that remuneration would be a significant attractor but drivers like vocational training and relatively minor dissatisfactions with the working environment are playing a large part in the junior feeling to move?

If so, then dedicating more resources to training activities and fine tuning the work environment could well be more effective in retention than increasing salaries alone.

Also it seems the locum ratio has tipped to the point where it is a long haul back no matter which solutions are employed.

I don't personally believe the remuneration is enough to change people's minds over the career paths they choose to embark on - the promise of $10,000 a year extra (pre-tax) for 5 years to train in a specialty I'm not really interested in seems a bit pointless. Similarly remuneration for working in hard-to-staff areas is limited by the fact that in most cases you need to change centres (or at least work at a tertiary centre) for vocational training (again, to qualify for the payment you could train in one of the hard-to-staff specialties - but this brings up point 1 again).

The waters are further muddied by the fact that in many cases, one does not merely walk into a training scheme - there's no guarantee that you will be accepted onto the training scheme of your choice on your first go, thus rendering your bonus void if you'd moved to a bigger centre in the hopes of getting onto a training scheme (since there are few training positions in the hard-to-staff rural centres).

There's also the issue that locum work in Australia (well, work in general) pays quite well. Hospitals are routinely offering rates of AUD$100-150 per hour - about 30-40% more than local locum rates, and about 3-4 times the usual hourly rate for a salaried hospital house surgeon or registrar. Why work in a hospital you don't want to, or train in a specialty that doesn't interest you, when you can do a six week locum in Australia and come back with the equivalent of a 5-year voluntary bond?

What probably needs to be done is a means to retain doctors in New Zealand universally, and not merely reward those who happen to work in certain rural centres, and who happen to train in certain specialties (it would be fascinating to do a survey on those who have applied for the voluntary bonding scheme to see whether a) it influenced their decisions, and b) whether they continued down the prescribed path).

There are a number of ways this could happen - for example, Australia has this fascinating tactic called 'salary packaging', where a portion of your public sector salary is nominally tax free, provided you provide proof/receipts of expenditure (categories which include rent/mortgage/power/phone, costs of training and curiously 'entertainment' which includes all meals out). A tax break for working in the public sector that ensures the money refunded is still spent within the country? Makes a hell of a lot of sense. In one of their more enlightened periods the DHBs also suggested student loan relief as a means to retain staff, but were told by the IRD that they could not do this without offering it to -all- public sector staff (at least, that's what they told us).

I don't believe the locum market in New Zealand is rampant - however it seems that the hard-to-staff rural centres still rely heavily on locum doctors of all grades (house surgeons, registrars and specialists). It doesn't take a genius to suggest that if they remunerated their salaried staff better, or provided better incentives for working in these hospitals, that they probably wouldn't need to spend so much on locums. Sadly, the DHBs operate on a policy that you have to prove benefit to justify expenditure - and it is impossible to prove what most people would consider quite obvious. The budget for locums, however, seems to be bottomless.

(I am currently a locum, but not entirely by choice - it was the only way I could take a reasonable amount of time off for study/personal reasons)

nakedmolerat

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#585416 22-Feb-2012 23:42

tedzart:....Doctors are not prepared to work 70 hours per week as was the "norm" for the Family GP.

are you prepared to work 70 hours per week?

70/7 = 10 hours per day (work daily) 8am - 6pm
70/6 = 12 hours per day (sun off) 8am - 8pm
70/5 = 14 hours per day (sat/sun off) 8am - 10pm

Jaxson

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#585467 23-Feb-2012 05:05

KevinL: quote]

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).

+1

You can't complain about there not being enough doctors and then also complain about women doctors who are at least working part time. There is a huge shortage of doctors in NZ. Just look at what's happening in Whanganui in their maternity section. Being qualified as a doctor doesn't instantly mean you have to work 70 hour weeks. Seeing a doctor at a time that suits us just isn't a right we have unfortunately.

The big problems are attracting doctors to the remote areas. I always thought the government should offer increased salaries for remote areas, or look at student loan contribution schemes if doctors took positions in remote areas for 3 or more years etc.

I agree with the issues surrounding doctor malls that have sprung up. Palmerston North has that issue with it's 'Palms' medical centre. We had a really great doctor there, but ended up looking elsewhere and were lucky enough to find another good family doctor. We moved away from the Palms when the earliest we could get an appointment was 4 - 5 days later, which just didn't sit with our expectations for our kids. That's where the money bit comes into it, in that these places are happy to take on more 'customers' regardless of what that actually means come service time.

tedzart

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#585468 23-Feb-2012 05:31

Dear NZtechfreak ... I did not recognize your sarcasm, nor do I have an interest in addressing the multi-factorial nature of the problem because I have broadly mis-attributed. The "broadly mis attributed" was put to me by a Doctor.

@ nakedmolerat ... why ask me if I am prepared to work 70 hours a week? That pertains to the hours that
my previous and other old school GP's put in.
I am an old man past his use by date and not in the work force anymore. Thanks for your input anyway.

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