Medical workforce development in New Zealand: insights from a medical programme

Abstract

New Zealand (NZ) has a reputation for excellence in medical education and training, and the cost-effectiveness of its health system. Like other Western countries, it is facing an immediate and major medical workforce crisis that is set to last for years. With little extra money available for education or health, the health demands from an ageing population and current inequities in delivery of care mandate an approach to obtain the most from every doctor trained. Medical schools have the responsibility for the selection and early education of these doctors. Student numbers in NZ have increased; however, given that the vast majority of medical students will complete their medical degree, then proceed to work in a medically-related area, the composition of student cohorts and their experiences during the medical programme, are fundamental early steps in the shaping of a future specialist workforce for the community’s needs. This thesis examines aspects of medical workforce development in NZ from the perspective of an educational leader in the Faculty of Medical and Health Sciences (FMHS) at The University of Auckland, provider of one of NZ’s two medical programmes. It describes ways that the FMHS is responding to the challenge to produce doctors with the aptitude to deliver the necessary medical care for its own community. It justifies endeavours already undertaken by the school, and clarifies ways in which medical schools, more widely, might enhance their contribution to the development of the future medical workforce. Within the thesis are reports of studies based on data from students and graduates of the Auckland programme. The first describes the work and life experiences of Auckland women medical graduates and explores how these women made career choices. This investigation found that lives of women outside medicine have remained remarkably similar over decades: most have children, and most wish to work flexibly over that time. More women are entering specialties other than general practice, but there are ongoing barriers to participation and progression to specialist level. A conclusion is that the health and education systems must adapt further to maximise the contributions and productivity of this half of the workforce. Subsequent studies relate to the demographics and career intentions of current medical students, and the impacts of their education thus far on that choice. These studies were made possible through the establishment of the FMHS Tracking Project in 2006; described in detail. Among other findings, insights are gained into ways that the proportion of medical students interested in a general practice career may be increased. The thesis concludes with the proposing of a framework within which medical schools and other stakeholders might consider selection of student cohorts and their education, as well as enhancing retention and workforce orientation towards the priority scopes of medical practice needed by the NZ community in the coming years.