Less than one in five overseas doctors who passed the New Zealand registration exam in the past year have found an intern’s job – the last hurdle to being able to practice in New Zealand.
Health Central has spoken to a number of overseas trained doctors calling for the return of a scheme that allowed experienced overseas doctors to be supervised in general practice rather than compete with New Zealand medical school graduates for limited junior doctor (resident medical officer or RMO) positions in public hospitals. The Medical Council has said that option is not available at “this stage” but did not rule out in the future accredited general practices being able to offer two-year internships to overseas doctors.
Bharti Arya’s ongoing frustration at her husband Dr Lalit Mohan still being unable to practice medicine after four years in New Zealand led her to lodge a Human Rights Commission complaint this week over the unfair pathway for doctors like her husband, who had practiced medicine for about a decade in his home country of India. The New Zealand Herald reported last year that the Human Rights Commission had received at least five complaints on the issue since 2012.
Arya says New Zealand says it is suffering from a doctor shortage but it is becoming “a graveyard” for a “hidden, underused” international medical graduate workforce who have passed the stringent Medical Council’s New Zealand registration exam (NZREX) but can’t practice as they are unable to meet the Council’s last registration requirement of gaining one of the very few RMO internships that aren’t taken by New Zealand graduates.
About 10 per cent of overseas doctors are required to sit and pass NZREX but in recent years there has been a growing log-jam of doctors passing NZREX competing for a handful of RMO positions that come up each year for non-New Zealand medical graduates. Only New Zealand and Australian medical graduates are eligible for government training subsidies for the two-year internship with the government subsidising in 2016 a total of 437 first year interns and 376 second years.
The latest Medical Council statistics showed that, as at March 26 this year, only one of the successful 19 candidates in the Council’s November 2017 exam had been able to get the required two year RMO internship at an accredited District Health Board. And in total only nine of the 52 successful candidates in the three NZREX exams held last year had managed to get RMO positions. An OIA request made in 2016 also revealed that none of the three metropolitan Auckland district health boards had employed NZREX graduates into first year intern positions between 2013-16.
Ready to serve internships in general practice
Health Central last week published an opinion piece by experienced South African GP Claire Terblanche who arrived in New Zealand late last year expecting that once she had passed the required exams she could continue practising to help reduce the “huge GP shortage” that she kept reading about.
She has since discovered that not only would she have to wait a year before she could sit the NZREX exam (which is only held three times a year with 28 candidates at a time) but she started reading the “disturbing accounts” of doctors passing NZREX but ending up giving up medicine disillusioned as they were unable to find an internship position within the five year time limit.
Terblanche made a number of suggestions to the Medical Council including rather than making it compulsory for all NZREX graduates to complete a two-year DHB internship that they make it possible for experienced overseas graduates to instead serve their two-year supervised internship in under-serviced communities.
Karla Minnitt, another experienced South African GP, who passed her NZREX exam in March this year said she was feeling quite despondent at her chances of gaining the required DHB internship position. She said a South African GP friend, had recently completed her two-year internship under the supervision of a GP and was now fully registered and working as a GP in the Manawatu. Minnitt said she had been told by the Medical Council that this pathway for experienced doctors was no longer open but she believed it was the solution.
“It solves the problem of no positions being available for foreign doctors as well as solves the problem of the massive shortage of doctors in New Zealand,” said Minnitt. She said she fully understood that “it was a given” that the intern positions must go to New Zealand graduates first but believed – for both the sake of the experienced NZREX graduates wanting to practice and the New Zealand health care system – that an alternative pathway should be brought back.
“I have an open work visa, I could literally start working tomorrow, but unfortunately my hands are tied!”
Arya agreed that an alternative pathway should be opened up for the possibly hundreds of doctors caught in the position like that of her husband who passed NZREX in 2016 but was unable to get an intern position. She said her Wellington-based husband had applied to nearly all of the DHBs from Dunedin to Auckland and was trying to keep up his skills by doing volunteer observer ships in local hospitals.
But he was getting increasingly frustrated after being unable to practice medicine for four years and was thinking of going back to India where had worked as a cardiologist. “Nobody wants to drive a taxi or work in hotels after spending so many years and so much money becoming a doctor,” said Arya.
Another NZREX doctor, who asked to remain anonymous, says he knows of about 60-70 doctors currently seeking places who could be helping New Zealand’s health system, including some who have resorted to driving taxis and working in fast food outlets.
The New Zealander, who headed overseas to get his medical degree after missing out on a place in medical school here, sat his NZREX exam in June last year and – after applying and visiting all the DHBs personally – had recently gained an internship position. “I was very fortunate to get a position in less than a year,” he said.
Now working in the New Zealand healthcare system he says he realised the doctor shortage was real and there was pressure on all doctors to work longer hours than rostered to meet demand. “I don’t know why RMO units are not hiring more doctors”.
He described the current NZREX registration requirements as a “really bad process” that nobody wants to take the blame for.
“The Medical Council says that they are only concerned with checking the competency of the doctors and they are not linked with trying to find employment for the doctors after the exams,” he said. “But the medical council knows that after the exam the doctors can’t find a job so why is the Medical Council taking the exam then?” He said DHBs were very happy to hire young doctors from the UK who usually only stayed for a short while before moving to Australia or returning home, whereas NZREX doctors were either New Zealand citizens or residents who want to stay in New Zealand and be a resource for the New Zealand health system.
Medical Council aware of ongoing issue
Medical Council chair Andrew Connolly said appreciated that it was a hard road for overseas doctors but the council’s function under the law was the protection of public health and safety.
“We are very keen to advocate with the DHBs to employ more NZREX doctors and get them off to a good start but we are not an employer,” he said. “I’m empathetic but it even states on our website very clearly that passing the NZREX exam is no guarantee of employment.”
Connolly acknowledged that there had been a decrease in the number of DHB RMO places available to NZREX graduates over the past four to five years.
He said this was due to a flow-on effect to the previous government increasing the number of New Zealand medical school places. The internship requirement had also been extended from one year to two years for all graduates under the new medical training framework.
But he said the impact of the higher cohorts of New Zealand medical graduates had now plateaued and anecdotally he had heard that the safer working hours now required for RMOs meant that at least some DHBs were taking on more NZREX graduates to meet the new rostering requirements.
Health Central has approached Central TAS (who administer the DHBs’ RMO recruitment process), the Auckland District Health Board and Northern Regional Alliance seeking more information but are yet to get clarification on current employment trends.
General practice internship pathway?
When asked about the previous pathway of a general practice internship opened to experienced doctors Connolly said that option “at this stage” doesn’t exist. He emphasised at “this stage” saying that new internship processes opened up the potential for general practices to be accredited to offer a two year internship.
He said that option came with a number of funding and employment issues but some practices were already taking RMO interns for short rotations and there was nothing to stop such a practice or other community provider like a hospice from seeking accreditation to offer an extended internship.
Connolly said the Medical Council had responded to the decrease in positions open to NZREX doctors by in 2014 reducing the number of times it offered NZREX from five times to three times a year. “We debated at length whether we should hold the exams at all – but there was overwhelming feedback from a whole variety of stakeholders – including DHBs and former NZREX doctors – to by all means reduce the number of candidates a year but do not scrap it because we still have a reliance on these doctors.
“Morally speaking we didn’t feel it was right offering endless exams if there was no hope of employment but on the other hand we thought it was not morally right to effectively stop any chance of a doctor from a country such as South Africa being able to work here – so we kept the exam going.”
He said that a large number of the about 1000 overseas medical graduates registered each year were young doctors from the United Kingdom coming on their “overseas experience” and were not required to sit NZREX as they were from a comparable health system. Only 111 of the overseas medical graduates registered in the year to June 2016 had sat NZREX
In total he said about 75 per cent – 494 of the 663 – international medical graduates who had been successful in passing the NZREX exam since 2004 had also been successful in gaining internships and becoming registered. Of those about 80 per cent were still practising in New Zealand. Research had also showed that NZREX graduates were no more or less likely to struggle during their RMO internship as New Zealand graduates and if they did it was mostly in their first three to six months of practice as they adjusted to the New Zealand health system and terms.