Rural Hospital and Doctors Survey 2009

The cross sectional study was conducted by the New Zealand Institute of Rural Health. Identified were rural New Zealand hospitals that provided 24 hour hospital care, had medical cover and were included on the Medical Council list of rural hospitals approved for training.

Questionnaires were sent to the managers of 29 hospitals and subsequently to Rural Hospital Doctors/MOSSes.

 

Survey Team

Ross Lawrenson Waikato Clinical School

Garry Nixon University of Otago

Robin Steed New Zealand Institute of Rural Health

Please click here for the presentation given by Professor Ross Lawrenson at the 2010 NZRGPN Conference.

Click here for the journal article “The rural hospital doctors workforce in New Zealand” published in Rural and Remote Health – Australia.

 

Rural Hospital Findings


Ownership Structure

• District Health Board 19

• Community Trust 7

• Local Authority Trading Enterprise 1

• Private 1

Characteristics

• 25/28 say they provide 24/7 medical cover

• Mean number of beds 19 (2-74)

• 4 have specialist staff

Staff Directly Employed

• 18/28 (64%) hospitals directly employ medical staff

• 12/19 (63%) DHB managed hospitals and 6/9 (66%) Trusts/other

• The managers stated that for these 18 hospitals they had
80.9 budgeted FTEs for generalists and 4.2 FTE for specialists

• At the time of the survey there were 53.9 employed FTEs (66% of
available positions), 19.5 Locums and 7.5 FTE were unfilled

• And 4.4 FTE specialists employed (104%) and 1 FTE locum

Credentialling

• 15/28 (53%) say they credential their doctors

• 14/18 (77%) hospitals that directly employ doctors said they had a
credentialing process

Please rate the availability of suitably qualified medical staff for New Zealand rural hospitals

• Oversupply 0

• Adequate Supply 0

• Shortage 8

• Serious Shortage 6

• Critical Shortage 12

Managers reported that 26 doctors had left in the last 2
years and 27 had been recruited

Please rate the availability of locum medical staff for New Zealand rural hospitals

• Oversupply 0

• Adequate Supply 2

• Shortage 8

• Serious Shortage 9

• Critical Shortage 5

Is there a designated medical leader e.g. clinical director?

• No 10

• Generalist 17

• Specialist 1

Is there an active process of clinical governance?

• Yes 18

– 4/18 said it was in early stages of development

– 4/18 indicated that it was done by the DHB

• No or not answered 10

 

Doctor Survey Results

Data on rural hospital doctors from Medical Council

• 107 doctors were identified by managers survey

• 27/107 (25%) were female

• Median Year of Graduation 1985

• Country of Qualification

– 38 (35%) qualified in NZ (10 Auckland, 28 Otago)

– 31 (29%) UK

– 11 South Africa

– 9 USA/Canada

– 4 Europe

– 3 Australia

– 11 other (India, Bangladesh, Sri Lanka, Iran, Iraq, Mexico,
Philippines)

• Type of Registration

– Vocationally registered 58

– General 45

– Provisional 4

• Type of Vocational Registration (Number=58)

• General practice 31

• Rural Hospital Medicine 15 (18 March 2010)

• Accident & Medical Practice 8

• Specialist 4

Data from Doctors Survey

• Response rate 69/107 (64%)

• Drs working in 27/28 of the hospitals surveyed

• 19/69 (27.5%) female

• Median age 47

• Median year of qualification 1985

• 32% New Zealand graduates

• Median number of years in employment was 6

• 42/69 (61%) employed by DHB, 17 by Community Trust and 10
“other”

• 62/69 (90%) had permanent employment

• 23/69 (33%) were employed full time

Alternative employment

• 29 also worked as GPs

• 3 had University appointments

• 2 worked in A&M centres

• Non-clinical consultancy/farming/hospitality

If you are a permanent employee have you worked additional shifts in the last month because of a lack of medical staff?

• 35/69 (51%) said they had done additional shifts to cover

Do you get regular guaranteed non clinical time?

• 29/69 (42%) said yes

• 15/42 (36%) DHB staff said yes

• 9/23 (39%) full time workers said yes

Within the Hospital is there any formal medical leadership? (E.g. Clinical Director)

• 23/69 (33%) said yes (14/27hospitals)

• 42 said No

• “From Chief Medical Officer indirectly and distantly”

• “I think the physician who visits once a week is probably the clinical
director”

• “No formal leadership but easy access to clinical leadership from
base hospital”

Do you have an active process of Clinical Governance?

• 34/69 (49%) said yes (19/27 hospitals)

• If yes, is it for the Hospital only?

– 22/34 said it was for the hospital only

• If no, what other areas does the clinical governance cover?

– GP

– Community health

– PHO clinics

Credentialing and CME

• There is a process for credentialing medical staff

– 36/69 (52%) said yes (18/27 (67%) hospitals

• Medical peer review occurs

– 50/69 said yes

• Regular medical continuing education sessions are available

– 45/69 said yes

What do you think can be done to improve the New Zealand Rural Hospital medical workforce?

• Better pay – 7

• Reduce on call demands – 6

• The development of the rural hospital fellowship and training – 12

• Better locum cover – 3

• Encourage medical students to look at rural (?bonding – 1) – 4

• Better relations/appropriate rotations with hospital doctors – 3

What do you think can be done to improve the New Zealand Rural Hospital medical workforce?

• Better access to CME – 5

• Better relationship/balance of management and clinical leadership – 5

• Use of technology e.g. video/teleconferencing – 3

Other Comments

• Reduce struggle with medical council

• Jobs for spouses, educational support for children, good housing and
child care

• More interesting work through decentralisation e.g. minor surgery,
gastroscopies etc. with appropriate training

 

Summary

• Mixed forms of employment and governance of rural hospitals

• Only identified 107 registered medical practitioners involved in
providing cover to rural hospitals. 65% were IMGs

• Of those surveyed 33% were full time rural hospital doctors.

• Hospital mangers that employed medical staff said that 33% of their
FTE were either unfilled or staffed by locums.

• There was a perceived major shortage of available staff and locums

• There are a significant proportion of hospitals that have no
recognised medical leadership, do not appear to credential their
medical staff and have no formal clinical governance structures

• This represents a major risk to the organisations and to their
patients especially given the large proportion of
generally/provisionally registered medical practitioners and the wide
use of locum staff.