Journal of the New Zealand Medical Association, 24-August-2007, Vol 120 No 1260
Strong forces at work on our senior doctors in New Zealand
Senior doctors (and dentists) employed by district health boards (DHBs) and who are among the around 92% who are members of the Association of Salaried Medical Specialists (ASMS) have their minimum terms and conditions of employment provided in their national multi-employer collective agreement (MECA).
Prior to 1992, senior doctors had historically been covered by national agreements but this was prevented by a combination of the now repealed Employment Contracts Act and the opposition of the National Party Government at that time. During 2003–04 the first MECA under the Employment Relations Act was negotiated, a complex task involving merging 21 separate collective agreements into one.
The first MECA expired on 30 June 2006 (it continues in force until a replacement is negotiated) and negotiations for the second commenced in late May 2006. Virtually since the commencement of negotiations the parties (ASMS and DHBs) have been at an impasse. Prior to the unprecedented national stopwork meetings held between 17 July and 9 August, there had been 24 days of negotiation including 10 with an external mediator.
The focus of the ASMS has been on recruitment and retention mindful of New Zealand’s historical vulnerability as a geographically isolated small country with a limited critical mass to sustain its medical workforce.
Our inability to retain the younger doctors that we train so well is increasing along with our dependence on recruiting in the highly competitive international medical labour market (of all OECD countries we have the highest proportion of overseas doctors). DHBs are also losing specialists, both in full and in time commitment, to the private sector.
The more expensive alternative to enhancing the MECA is the use of external locums whose costs are currently running (both resident and senior doctors) at over NZ$100 million. These have more than doubled over the past 6 years.
Specifically, while looking over our shoulders at recent Australian settlements which significantly enhance terms and conditions in response to their own serious shortages, the ASMS focussed on retention in the first instance (the better our retention the stronger our ability to recruit) but to also structure the MECA in such a way as to be more internationally attractive.
The gap between Australia and New Zealand is simply too great (after 7 years a specialist in the Australian state of New South Wales will earn at least A$50,000 more than a specialist in New Zealand) to achieve parity. In fact, many packages in Australia are between 50% and 100% greater than those in New Zealand.
Achieving parity with Australia is simply too much in our small country. Instead the ASMS has endeavoured to be smarter through means such as increasing the length of the salary scale higher to around the same level as in Australia (even if it still takes longer to get there); doubling the size of CME expense reimbursement to NZ$16,000 (even though still well short of the nearly A$28,000 in New South Wales); and increasing the rate for working on after-hours call and shifts to double-time recognising that this work is more pressurised than in Australia because of the latter’s natural critical mass advantage. We are also seeking an appropriate salary increase not less than the rate of inflation in order to give a retention message that DHBs value senior doctors.
Improving the MECA to partially offset the large advantage Australia has in competing against us for overseas-trained doctors and recruiting specialists in New Zealand is only part of what is required to address our vulnerability. Other measures, in particular by enhancing job satisfaction and clinician leadership, are also required but an enhanced MECA is an important part of the mix.
The DHBs have responded negatively to this challenge by seeking to constrain expenditure to the Government’s future funding track (estimated inflation over the next 3 years minus 0.5% in each year) which precludes the achievement of the ASMS’s objective of a more competitive and attractive MECA for recruitment and retention.
In addition, in what can only be described as a strategic blunder, they have sought to disempower and de-professionalise senior doctors, as well as increase managerial power, through counter-claims that seek to undermine time for non-clinical duties, sabbatical and consultation rights.
The ASMS was caught somewhat off-guard by the immediate extent of the Australian threat. But extensive anecdotal reports of westwards Tasman migration suggested that the situation was much worse that when our negotiations commenced in May 2006.
In July 2007 we conducted an electronic membership survey asking for the names of specialists who had resigned to take up positions in Australia since January 2006. This survey technique would inevitably understate the true picture but it nevertheless revealed a major threat to the viability of many specialist services in New Zealand with 80 specialists identified or around one a week.
Whether one looks at it as being nearly equivalent to the entire senior medical workforce of a medium size DHB, or the capacity to devastate specific services such as has already occurred with paediatric oncology in Wellington, the implications suggest a crisis.
In response to the (by now over 13-month) long impasse in negotiations, the ASMS took the unprecedented step of convening national stopworks. The DHBs’ advocate embarked on a campaign to undermine them by a variety of means. He misused Medical Council data. He claimed that the number of specialists employed had increased by nearly 300 between 2000 and 2005. However, he neglected to mention that this increase occurred up until 2004 with a new development in 2005, a slight decline. Further, the increase was embellished by the addition of Council approved vocational registration for five new branches of medicine (general registrants became specialists in effect by a stroke of a pen).
Other means included exaggerating the cost of the ASMS claims (by including existing operational costs), exaggerating the financial benefits of their position by a similar technique, and fabricating the average earnings of specialists in an attempt to embarrass them.
However, these efforts failed with the meetings attracting overwhelming attendances. The smallest was 8 in Westport (100% turnout) and the largest was around 260 in Auckland DHB; around 1740 doctors in total.
Of this number, a mere 4 voted to accept the DHBs’ proposal for settlement. Further, less than 50 voted against a recommendation that a national ballot be conducted on limited industrial action (excluding acutes and emergencies) should the impasse continue. There is a growing appreciation that the risks of inconveniencing patients during strikes is less than the longer term inconvenience and risk of harm of a medical workforce crisis.
If a further escalation in this bitter industrial dispute is to be prevented then the DHBs will need to come out of their corner and move from their own arbitrary parameters which are contrary to the objective of recruiting and retaining a sustainable quality senior medical workforce in New Zealand’s publicly provided health system.
Competing interests: None.
Author information: Ian Powell, Executive Director, Association of Salaried Medical Specialists (ASMS), Wellington
Correspondence: Ian Powell, Association of Salaried Medical Professionals, PO Box 10 763. Wellington. Fax: (04) 499 4500; email: firstname.lastname@example.org
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