New Zealand’s relatively small and widely dispersed population creates challenges for the delivery of health services outside metropolitan areas.
In addition, changes in clinical practice can lead to workforce shortages. For example, interventional radiology is experiencing a growth in activity. As a result, there are global workforce shortages.
HWNZ administers the Voluntary Bonding Scheme and the Advanced Training Fellowship Scheme to address recruitment, retention and distribution issues. A demonstration of a rural immersion programme is also underway, with HWNZ support.
* Including 136 GP trainees.
The Voluntary Bonding Scheme (VBS) was set up in 2009 to encourage doctors, nurses and midwives to work in places and specialties that are recognised as hard to staff.
The VBS calls for medical, nursing and midwifery students to register on the Scheme when they graduate, and then work for three to five years in a hard-to-staff community or specialty. At the end of three years, they are eligible for their first payment under the Scheme.
Payments are made at a rate of $2,833 a year for nurses; $3,500 a year for midwives; and $10,000 a year for doctors. This means that a doctor who takes part in the Scheme for five years can earn $50,000 towards paying off a student loan.
Medical physicists and radiation therapists were added in 2012 to address a trend of graduates leaving for higher salaries overseas. In 2013, the terms and conditions were changed to encourage postgraduate doctors to take up GP training with rural or provincial general practice trainers. Sonographers will be included in 2015.
In total, $15 million has been paid out as of 30 June 2014 to those who meet the requirements. Since 2009, 1230 payments have been made to 700 eligible participants.
The Minister of Health takes into account advice from the sector when considering which communities and specialties will be included each year.
Appendix 2 provides maps of the 2015 hard-to-staff communities for doctors, nurses and midwives.
Table 3: Hard-to-staff specialties for 2015
* Including 29 GP trainees.
Of the graduates who registered in 2014, 88 percent are women and 12 percent are men; 7.8 percent are Māori and 2.2 percent are Pacific peoples.
The occupations with the highest percentages of Māori graduates are doctors (12.9%) and radiation therapists (13%).
Women account for almost two-thirds of the 63 doctors registered on the Scheme. Midwifery registrants are wholly female, and 91 percent of the 324 nurses are women. Men predominate only among medical physicists, with two men and one woman signing up in 2014.
Not all graduates who register decide to continue to work in hard-to-staff specialties or communities. They are free to withdraw at any point without penalty. Although this means they will no longer be eligible for payments, they will have made a contribution, and could in the future, return to areas experiencing workforce shortages.
It is too early yet to determine whether working in hard-to-staff specialties and communities affects participants’ long-term career choices. However, the level of interest so far gives rise to cautious optimism about the VBS’s potential to improve workforce distribution. More information can be found at www.health.govt.nz.