Doctor shortage symptom of Labour neglect and bureaucracy

With hospitals throughout the country facing critical staff shortages, Rotorua Hospital is the latest to admit services are suffering due to a desperate shortage of junior doctors, says National Party Health spokesman Tony Ryall.

"Outpatient clinics have been cancelled, and doctors say forced delays in seeing a specialist could mean more people will get sicker in the community and end up in the emergency department.

"This demonstrates the nonsense of Labour's claim that staff shortages are not having an impact on patient care. They clearly are."

Mr Ryall says senior staff are having to fill the gaps after Rotorua Hospital was able only to fill three of its seven registrar vacancies last November.

"This is a recipe for disaster. Fatigued staff don't always make good decisions no matter how good a doctor they are."

The registrar shortage in Rotorua follows similar reports from Auckland recently.
"It would appear to be a nationwide problem, but it isn't new," Mr Ryall says.
As far back as 2005, registrars at Rotorua Hospital were complaining about overwork, fatigue, and the potential safety risks to patients.

"In National's health discussion paper, we canvas the idea of bonding new doctor graduates to regional centres in return for student loan concessions. This could help in situations like these. Retaining existing staff and slowing the flood of health professionals to Australia would also help."

Mr Ryall says there are well publicised workforce shortages in other areas too, including senior doctors, midwives, and paediatric oncologists in the capital, to name a few.

"Labour has utterly failed to plan properly for the changing population. Labour has managed to recruit an army of more than 10,000 bureaucrats, but they haven't been able to put enough doctors in hospital wards.

"Now that he's apparently 'running the show', Health Minister David Cunliffe should set about fixing the crisis his predecessors watched unfold before them."

Below: Daily Post articles

Daily Post 15/01/08
Doctor Shortage Grips Hospital
Health: Skilled staff still looking elsewhere for work
BY ALISON BROWN

A DOCTOR shortage at Rotorua Hospital will have far-reaching effects as outpatient clinics are cancelled, leaving patients in limbo.

Patients are having to wait longer for specialist assessments as senior doctors work night shifts to cover for a shortage of registrars at Rotorua Hospital.

The shortage has forced the cancellation of outpatient clinics and it's feared the problem could take months to fix.
Doctors say any lengthy delay to see a specialist could see more patients getting sicker in the community and ultimately, ending up at the hospital's emergency department.

Every November Rotorua Hospital receives an intake of medical graduates and junior doctors. Last year, however, it attracted only three medical registrars - two full- time and one part-time. There were seven vacancies.

Registrars are doctors with two to three years' hospital-based experience. They supervise graduates, or house officers, and are responsible for admitting patients and planning their treatment.

Registrars report to senior staff, or consultant physicians.

The shortage means the Lakes District Health Board has to plug the gap with locums but even they are in short supply. Consequently, consultant physicians are working weekends, evenings and night shifts to ensure the hospital can provide a safe level of care.

It also means there are fewer consultants during the day which has seen nearly all outpatient clinics cancelled.

This affects patients who need specialist follow-up care after being discharged from hospital or patients needing assessments after being referred by their GP.

Cancelled clinics include those for diabetes and heart patients.

Lakes District Health Board general manager for clinical services Dale Oliff said the hospital was ``very dependent'' on registrars and everything possible was being done to remedy the situation.

Discussions are underway with overseas candidates from the UK, Australia and Sri Lanka who could be employed full-time ``in the next month or so''.

She said medical registrars were often in short supply but this year was the first time in three or four years Lakes had recruiting problems.

The problem arose when no second-year house officers elected to stay on at Rotorua Hospital.

Waikato DHB also supplies Lakes with medical registrars as part of their emergency department training programme but Waikato was only able to supply one this year, Ms Oliff said.

Dr Jared Green, a senior house officer at Rotorua Hospital's emergency department, represents registrars and graduates as the Resident Doctors' Association (RDA) representative.

He said the shortage was taking its toll on senior staff.

``Specialists are working outside their normal role by doing nights. During the day we try not to ring them so they can get some sleep.''

Working with locums and different staff everyday meant there was less of a ``collegial'' atmosphere. ``One of the benefits of working in a provincial hospital is having that familiarity. We don't have that now.''

He expected the disruption to outpatient services to affect the community if more permanent registrars weren't found.

GPs with patients who need urgent specialist assessments are arranging for them to be seen by a consultant in the emergency department.

Rotorua GP Clem Le Lievre said the hospital was coping well with the shortage but the real test would come when the number of non-
urgent cases ``bulged'' and registrar vacancies weren't filled.

NZRDA secretary Deborah Powell said the registrar shortage was a national problem and highlighted the need for district health boards to recognise the junior doctors' need for a pay rise.

Last year 30 medical graduates left for Australia where junior staff were paid 80 per cent more than their New Zealand counterparts.

Daily Post – 12/11/2005

Rotorua doctors working 'unsafe' hours

By ALISON BROWN in Rotorua
Junior doctors at Rotorua Hospital say they're so overworked they avoid driving home at night for fear of falling asleep behind the wheel.

Fatigue is such an issue, they say, they are more likely to take a taxi or stay at the hospital overnight.

Rotorua's doctors, who threatened strike action last year due to what they called unreasonably long shifts, are backing the findings of a nationwide survey of their colleagues which revealed young doctors are dangerously overworked.

However, the Lakes District Health Board insists it has checks in place to ensure burnt-out doctors are not endangering patients.

The Massey University survey of nearly 1400 junior doctors found some are working more than 70 hours a week. Nearly half reported they had fallen asleep at the wheel driving home from work and four out of 10 said they had made a fatigue-related medical error over a six-month period.

Carl Huxford, a surgical registrar at Rotorua Hospital, agreed fatigue was an ongoing concern.

As part of a contract with district health boards, registrars are not supposed to work more than 72 hours a week. But Dr Huxford said it was typical for surgical registrars to work more than the maximum once a month.

"We're rostered on for less than 70 hours a week but it's not always practical for a hospital of this size to have a lot of staff on," he said. "If work has to be done, someone has got to do it." Dr Huxford regularly works 8am to 11pm but can occasionally be called back to work before 8am the next morning.

"That can happen twice a week which means you can be at the hospital for nearly 24 hours."

Long hours affected registrars in different ways, but it was common for them to be tired and grumpy, he said.

"You don't always work efficiently so that means there are days when you don't enjoy work as much. You're more tired outside of work as well and that can be frustrating."

There had been times when he was so tired at the end of a shift, he took a taxi home or slept at the hospital to avoid driving home.

Although only 40 per cent of doctors surveyed admitted to making a medical-error due to fatigue, Dr Huxford said he thought the problem was more widespread. Doctors had to remember extensive information and may not get much time to record everything.

"You might have 15 minutes' worth of information in your head but you might only get five minutes to write everything down."

Another junior doctor, Anne-Marie Yardley, stressed Rotorua Hospital was "not as bad" for overworking its staff as others around the country.

The Resident Doctors' Association, which represents junior doctors, has rated the Lakes District Health Board as the top-rating health board for junior doctor placings for the past three years.

Communications officer Sue Wilkie said the health board had processes to limit the number of hours junior doctors worked, with most working no more than 55 hours a week.

Asked what checks were in place to ensure overworked doctors were not risking the safety of patients, Miss Wilkie said senior doctors provided supervision and made sure their younger colleagues followed strict health and safety practices.

A spokeswoman for the doctors' union, Deborah Powell, said the present situation in many hospitals was "not acceptable".

"Doctors are still working 10-day shifts without a break, but that's certainly an improvement on the 12 days previously, and night shifts are now limited to four consecutive shifts instead of seven.

"If we improve conditions for doctors, we will also improve conditions for patients.

"If doctors are happy and healthy, their patients will be better off too."

additional reporting NZPA